Prolonged postischemic regional left ventricular delayed relaxation or diastolic asynchrony detected by color kinesis following coronary vasospasm

Effects of Postischemic Regional Left Ventricular Diastolic Wall Motion Abnormalities or Delayed Relaxation Following Coronary Vasospasm on Global Diastolic Function

“…The CK-diastolic index was defined as the LV segmental filling fraction during the first 30% of the diastolic filling time (LV segmental cavity area expansion during the first 30% of diastole, divided by the segmental end-diastolic LV cavity area expansion, expressed as a percentage). [12][13][14] The mean CK-diastolic indexes in 40 age-matched control subjects were 71±6, 72±7 and 75±7% in the territory of AS, LAT and INF, respectively. Intraobserver variability of the CK-diastolic index was 6.5±3.4% (n=18).…”

“…A custom software program was used to extract endocardial expansion for myocardial segments in the LV midpapillary shortaxis view, as reported previously. [12][13][14]16,17 The timing of color encoding was set to begin at the first frame in which outward endocardial motion was noted, and its duration was set to its maximal value (33 ms × 19 frames). The sites of regional LV diastolic wall motion or regions of interest were set on the basis of standard segmentation models corresponding to the 3 major coronary perfusion territories assigned as follows (Fig 1) 18 : (i) the anterior and anteroseptal segments (AS) to the left anterior descending coronary artery (LAD); (ii) the anterolateral and posterolateral free wall segments (LAT) to the left circumflex branch (LCX) or the diagonal branches originated from LAD; and (iii) the posteroseptal and inferior segments (INF) usually to the right coronary artery (RCA).…”

“…10,11 Recently, we have found using this method, that impaired or stunned regional diastolic function with delayed outward wall motion persisted beyond recovery of ischemia commonly in patients with coronary vasospasm. [12][13][14] This diastolic dysfunction is specifically caused by postischemic damage because it is completely recovered. The present study was designed to determine how the global diastolic function was affected by impaired regional LV wall motion or diastolic asynchrony following coronary vasospasm in patients with single or multivessel coronary vasospasm.…”

“…Some patients had been involved in previously reported studies. [12][13][14] In all patients, coronary artery spasm (transient total or subtotal occlusion) associated with ST segment elevation (≥0.1 mV) on the electrocardiogram and/or typical chest pain was angiographically demonstrated in at least one of the major coronary arteries during angina and was provoked by an intracoronary injection of acetylcholine. 15 The spasm was relieved spontaneously within 2 min or otherwise by intracoronary administration of isosorbide dinitrate.…”

Appearance of Electrocardiographic Initial U‐Wave Inversion Dependent on Pressure‐Induced Early Diastolic Impairment in Patients with Hypertension

“…Recently a color kinesis study was reported to demonstrate that the LV regional outward motion during early diastole was impaired in the LAD perfusion territory in patients with recent LAD spasm. 14,15 Stunned myocardium with impaired early relaxation in the LAD perfusion territory due to repeated spasm was observed even during the attack-free period in these patients. Such impaired early relaxation was probably 594 Clin.…”