Effect of Dobutamine on Regional Diastolic Left Ventricular Asynchrony in Patients With Left Ventricular Hypertrophy. On-Line Quantification Using Automated Segmental Motion Analysis System.

bnormalities of left ventricular (LV) filling and relaxation are sensitive early signs of myocardial ischemia in acute experiments involving animals and humans. [1][2][3][4] It is reasonable to assume that good quantitative analysis methods should detect differences between ischemic and non-ischemic myocardium very accurately. 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 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. 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. Methods Study PatientsConsecutive 18 patients (11 men and 7 women with a mean age of 62±9 years; range: 37-77 years) with variant angina having a recent history of repetitive angina, coronary vasospasm induced by intracoronary injection of acetylcholine during coronary arteriography, good echocardiographic image quality and adequate tracking by CK but without any types of arrhythmias or conduction disturbance, were subjected to the present study. Patients with a significant (>75% luminal diameter) organic coronary stenosis or apparent systolic regional LV dysfunction were Background Regional left ventricular (LV) diastolic wall motion abnormalities detected by color kinesis (CK), an echocardiographic technique, may be a more sensitive measure to postischemic damage following coronary spasm than parameters of global diastolic function. Methods and ResultsRegional LV diastolic wall motion was evaluated by using CK in 18 patients with variant angina on the day following coronary spasm, which was induced by intracoronary acetylcholine. Fractional regiona...

Section: Study Limitationsmentioning

confidence: 99%

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

Miwa

Ishii

Makita

et al. 2005

“…More recently, Liu et al developed an automated segmental analysis system based on an automatic border detection technique and evaluated the effect of dobutamine on LV systolic and diastolic asynchrony in patients with LV hypertrophy caused by systemic hypertension. 18 CK is also based on acoustic border detection and allows real-time assessment of endocardial contraction or expansion on a regional basis. [6][7][8][9] In the present study, asynchronous ventricular filling was improved after intravenous diltiazem, as expressed by the decrease in the asynchrony index throughout diastole, which is consistent with the findings of the study using verapamil.…”

Section: Discussionmentioning

confidence: 99%

Acute Effects of Diltiazem on Regional Left Ventricular Diastolic Filling Dynamics in Patients With Hypertrophic Cardiomyopathy as Assessed by Color Kinesis

Ito

Suwa

Imai

et al. 2004

eft ventricular (LV) diastolic function is impaired in patients with hypertrophic cardiomyopathy (HCM) because of impaired relaxation and increased chamber stiffness 1,2 and is related to the extent of spatial and temporal heterogeneity during diastole. Studies using invasive and noninvasive techniques have demonstrated a non-uniform filling process in patients with HCM. [2][3][4] One such study showed that the calcium antagonist, verapamil, improved the heterogeneity of LV filling in HCM patients. 3 There are no data regarding the effect on the regional filling dynamics in these patients of another calcium antagonist, diltiazem, which depresses the heart less than verapamil and therefore has a lower incidence of adverse effects. 5 Color kinesis (CK) is a real-time echocardiographic technique that is useful for assessing regional LV systolic and diastolic function 6-10 and was used in the present study to examine the acute effects of diltiazem on the regional LV filling dynamics in patients with HCM. Methods Study PopulationNineteen patients with HCM (13 men, 6 women; age 55±15 years, range: 27-75) were enrolled in this study. None had LV outflow obstruction nor had any been taking

“…The accuracy of the LV volume calculated by the software was established by comparison with other modalities. 8 In phase analysis, in contrast to evaluation of the change in the regional ventricular count, we assessed the change in the LV wall thickness by measuring the regional count per pixel based on the partial volume effect. A linear correlation between the regional count and wall thickness has been demonstrated by a phantom study in which the object size was 2-fold smaller than the spatial resolution (FWHM) of the SPECT image.…”

Section: Relationship Between the Peak Contraction Phase (Sdp) And Thmentioning

confidence: 99%

Relationship Between Asynchronous Myocardial Contraction and Left Ventricular Systolic and Diastolic Function-Assessment Using the ECG-Gated Polar Map With 99mTc-Methoxy-Isobutyl Isonitrile-

Sugihara

Yonekura

Matsumoto

et al. 2005

synchronous myocardial contraction occurs with myocardial disorders such as dilated cardiomyopathy, 1 left bundle-branch block 2 and ischemic heart disease, 3 and is believed to decrease both systolic and diastolic cardiac function. However, there are few methods of quantitating the 3-dimensional (D) asynchronous myocardial contraction and the relationship between asynchrony and cardiac function has not been clarified quantitatively.Left ventricular (LV) function has been evaluated clinically by echocardiography 4 and by ECG-gated blood pool study, 5 and novel echocardiographic methods 6-8 such as tissue Doppler imaging and ECG-gated single-photon emission computed tomography (SPECT) 9 have been developed. In particular, quantitative gated SPECT software (QGS; Cedars-Sinai Medical Center, Los Angeles, CA, USA) enables evaluation of LV function by accurately determining the inner edge of the left ventricle. 10,11 However, we cannot use these methods to quantitate the 3-D heterogeneity of myocardial contraction, because the motion of the Circulation Journal Vol. 69, February 2005 inner edge of the ventricle does not always concord with the regional wall thickening.To evaluate asynchrony of regional myocardial contraction, we used 99m Tc-methoxy-isobutyl isonitrile (MIBI) to construct an ECG-gated polar map and regional contraction curve based on the fact that the ventricular wall thickness correlated with the regional myocardial count. We then compared the results of QGS software and Doppler echocardiography in a patient with an old myocardial infarction (OMI) to test the hypothesis that asynchrony decreased cardiac function by disturbing the harmonic contraction and relaxation of the myocardium. Methods Patient PopulationThe study group comprised 12 normal subjects (11 males, one female, aged 64±10 years) and 38 patients with an OMI (ie, ≥3 months after onset; 34 males, 4 females, aged 67±9). Patients with arrhythmias, valvular heart disease, small ventricle (end-diastolic volume <50 ml) and myocardial hypertrophy were excluded, as were patients with a complete perfusion defect. Data Acquisition and AnalysisAfter injection of 1,000 MBq of 99m Tc-MIBI, ECG-gated SPECT was performed using an L-shaped dual detector gamma camera (Optima NX; GE Medical Systems, Background To quantitate the degree of 3-dimensional asynchronous myocardial contraction, an ECG-gated polar map method was developed with 99m Tc-methoxy-isobutyl isonitrile, and used to investigate the relationship between asynchrony and left ventricular (LV) function. Methods and ResultsTwelve normal subjects and 38 patients with an old myocardial infarction were studied with ECG-gated single-photon emission computed tomography (SPECT). In each frame, a myocardial perfusion polar map was reconstructed and the peak contraction phase in each pixel was displayed (phase map). The degree of asynchronous contraction was assessed from the standard deviations of the peak contraction phase (SDP) on the phase map. Ejection fraction (EF), peak ejection rate (PER), 1/...