Characteristics of Myocardial Postsystolic Shortening in Patients with Symptomatic Hypertrophic Obstructive Cardiomyopathy before and Half a Year after Alcohol Septal Ablation Assessed by Speckle Tracking Echocardiography

Abstract

ObjectivesPostsystolic shortening (PSS) has been proposed as a marker of myocardial dysfunction. Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that results in sustained improvements in atrial structure and function. We investigated the effects of PTSMA on PSS in HOCM patients using speckle tracking imaging.MethodsConventional echocardiographic and PSS parameters were obtained in 18 healthy controls and 30 HOCM patients before and half a year after PTSMA.ResultsCompared with the healthy controls, the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. At 6 months after PTSMA, both the number of segments having PSS (10.5±2.8 vs. 13.2±2.6; P<0.001) and the average value of PSS (−1.24±0.57 vs. −1.55±0.56; P = 0.009) were significantly reduced. Moreover, the reductions in the average value of PSS correlated well with the reductions in the E-to-Ea ratio (r = 0.705, P<0.001).ConclusionsBoth the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. PTSMA has a favourable effect on PSS, which may partly account for the persistent improvement in LV diastolic function in HOCM patients after PTSMA.

Fetal Postsystolic Shortening Assessment by Myocardial Deformation Imaging

“…Absence of hypertrophic response might occur because of relative ischemia of the endothelial layer or as a sign of myocardial fibrosis correlating PSS with ischemia. 18 Finally, indices of myocardial deformation were also not significantly different between FGR cases with and without PSS. These 2 subgroups are small, the myocardial indices were not corrected for gestational age, and little is known about the feasibility and reliability of the strain and strain rate measurements, optimal region of interest size (in fetuses of different gestational age), strain length, and beat to beat variation.…”

“…In patients with hypertrophic cardiomyopathy, pathological PSS is found more regularly. In patients with hypertrophic obstructive cardiomyopathy, 18 PSS can delay myocardial relaxation resulting in an increased left ventricular filling pressure, defined as increased E/E′ ratio, with a reduction in the average value of PSS and E/E′ ratio already 6 months after alcohol septal ablation. Presence of pathological PSS, which may exceed far over aortic valve closure with a reduced overall strain, was observed in both ischemic and scarred segments in coronary artery disease or ischemia.…”

Pseudo-Paradoxical Jet Flow in a Patient with Midventricular Obstructive Hypertrophic Cardiomyopathy

“…Longitudinal strain on speckle-tracking revealed delayed LV peak contraction in each segment after closure of the aortic valve. This is known as postsystolic shortening (PSS) 7 and may represent continued contraction during IVRT. PSS has been reported as a marker of myocardial ischemia and fibrosis and is frequently observed in hypertrophic cardiomyopathy.…”