Association of asynchronous protodiastolic segmental wall motion with impaired left ventricular relaxation.

Abstract

SUMMARY To determine if asynchronous segmental relaxation is associated with altered left ventricular (LV) diastolic function, we examined systolic and diastolic wall motion and function indexes in 16 patients without and 16 with asynchronous relaxation (groups 1 and 2, respectively). The segment with asynchronous relaxation was observed most frequently in the free anterior LV wall and was not consistently related geographically to coronary stenosis, nor to systolic asynergy in the same region, but was frequently accompanied by simultaneous segmental inward motion elsewhere in the ventricle.LV chamber volume stiffness during diastolic filling and at end-diastole was statistically similar in each group. Conversely, both T (58.3 ± 2.3 msec vs 41.0 ± 3.6 msec) and the isovolumic relaxation period (140.9 ± 7.5 msec vs 116 ± 6 msec) were significantly more prolonged, peak negative dP/dt was lower (1314 ± 57 mm Hg/sec vs 1604 ± 114 mm Hg/sec), and the y-axis intercept of the diastolic pressure-volume curve was higher in group 2 patients (7.96 ± 0.98 mm Hg vs 4.88 ± 0.93 mm Hg) (p < 0.05 for each), indicating impaired relaxation and altered diastolic tone.With improved systolic function and relaxation properties after nitroglycerin, both the asynchronous outward relaxation and the inferior segment of simultaneous inward motion were ameliorated. Conversely, with increased ventricular preload and afterload induced by isometric exercise, both the asynchronous segmental outward motion anteriorly and the inward motion inferiorly were exaggerated.Asynchronous segmental relaxation may represent a compensatory mechanism in areas of normal contraction that offsets abnormal inward motion elsewhere, tending to maintain isovolumic status of the ventricle.OUTWARD segmental left ventricular (LV) wall motion during the isovolumic relaxation period of diastole is frequently observed in left ventriculograms of patients who undergo diagnostic cardiac catheterization. Gooch et al. ' initially described this phenomenon in patients with mitral valve prolapse, and attributed it to a functional myocardiopathy; however, it has more recently been reported both in normal subjects2 and patients with coronary artery disease.

Assessment of regional left ventricular relaxation in patients with coronary artery disease: importance of geometric factors and changes in wall thickness.

“…In this respect, the Janz approach appears more complete, since it also takes into account the changes in ventricular geometry that consistently occur in early diastole when global relaxation is impaired. 17 In summary, the local wall stress computations performed in this study can be regarded, at best, as rough approximations of reality. As such, these computations already emphasize highly significant abnormalities in diastolic stress, which could not have been suspected by analyzing left ventricular pressure exclusively.…”

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

“…A number of non-invasive indexes of diastolic function have been proposed by the analysis of M-mode echocardiograms, Doppler LV filling velocity patterns, and radionuclide ventriculograms. [5][6][7] Diastolic function as assessed with these indexes is frequently abnormal, even in patients with ischemic heart disease in whom systolic function is maintained within normal ranges. [5][6][7] Indeed, the beginning of the regional LV outward wall motion in the isovolumic relaxation phase is delayed in the coronary involved region.…”

“…[5][6][7] Diastolic function as assessed with these indexes is frequently abnormal, even in patients with ischemic heart disease in whom systolic function is maintained within normal ranges. [5][6][7] Indeed, the beginning of the regional LV outward wall motion in the isovolumic relaxation phase is delayed in the coronary involved region. 5,6 Because the impaired region is confined to the underperfused area of the involved coronary arteries, and ischemic damage may not necessarily result in impaired global LV diastolic function; the measure of the LV regional diastolic function may provide a more sensitive estimate of the coronary involved region than the measure Circulation Journal Vol.69, April 2005 of global LV function.…”

“…[5][6][7] Indeed, the beginning of the regional LV outward wall motion in the isovolumic relaxation phase is delayed in the coronary involved region. 5,6 Because the impaired region is confined to the underperfused area of the involved coronary arteries, and ischemic damage may not necessarily result in impaired global LV diastolic function; the measure of the LV regional diastolic function may provide a more sensitive estimate of the coronary involved region than the measure Circulation Journal Vol.69, April 2005 of global LV function. 8,9 Color kinesis (CK; Philips Medical Systems, Andover, MA, USA) has been recently developed to facilitate the echocardiographic evaluation of regional wall motion.…”

Improvement in regional wall motion and left ventricular relaxation after administration of diltiazem in patients with coronary artery disease.

“…The improvements in regional systolic contraction may have correlated with more rapid local left ventricular relaxation. Ludbrook et al 50 noted improvement in regional left ventricular relaxation associated with reversal of regional wall motion abnormalities after administration of nitroglycerin in patients with CAD. We did not measure regional relaxation and this must be considered a limitation of our study, but the increase in global left ventricular relaxation rate after diltiazem that was associated with improvement in regional left ventricular systolic function does support the concept that in our patients, relaxation and contraction abnormalities in CAD areas were interrelated.…”