Document Detail

Impaired subendocardial wall thickening and post-systolic shortening are signs of critical myocardial ischemia in patients with flow-limiting coronary stenosis.
MedLine Citation:
PMID:  21628833     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The early diagnosis of myocardial ischemia is still challenging. The aim of the present study was to determine whether subendocardial hypokinesis and post-systolic contraction could be early markers of myocardial ischemia.
METHODS AND RESULTS: Thirty-one consecutive patients with flow-limiting severe coronary stenosis but without visually abnormal left ventricular wall motion underwent quantitative echocardiography. Myocardial strain was measured using layer-by-layer analysis in severely hypoperfused segments. Radial strain (RS) was measured in the subendocardial, subepicardial, and total wall (innerRS, outerRS, and totalRS, respectively). Circumferential strain (CS) was also measured as 3 separate layers: subendocardial, mid-layer, and subepicardial layers (innerCS, midCS, and outerCS, respectively). Post-systolic shortening (PSS) was defined as the peak strain after end systole, and post-systolic strain index (PSI) was calculated as PSS divided by end-systolic strain. TotalRS was similar between ischemic and normally perfused segments, but innerRS and inner/outer RS ratio were significantly smaller in the ischemic segments than in corresponding segments in healthy subjects. Receiver operating characteristic analysis identified an optimum cut-off for PSI of 0.6. The combined criteria of inner/outer RS ratio <1.0 and PSI >0.6 achieved 95% specificity for the presence of flow-limiting stenosis.
CONCLUSIONS: Combined assessment of both subendocardial contractile impairment and PSS is very useful in identifying a severely hypoperfused left ventricular wall even without visual wall motion abnormality.
Tomoko Ishizu; Yoshihiro Seo; Masako Baba; Tomoko Machino; Haruhiko Higuchi; Junji Shiotsuka; Yuichi Noguchi; Kazutaka Aonuma
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Publication Detail:
Type:  Journal Article     Date:  2011-05-31
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  75     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2011  
Date Detail:
Created Date:  2011-07-25     Completed Date:  2011-11-18     Revised Date:  2012-01-09    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1934-41     Citation Subset:  IM    
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Japan.
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MeSH Terms
Coronary Stenosis / pathology,  physiopathology*,  ultrasonography
Heart Ventricles* / pathology,  physiopathology,  ultrasonography
Middle Aged
Myocardial Contraction*
Myocardium / pathology*
Comment In:
Circ J. 2011;75(8):1825-6   [PMID:  21727751 ]

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