Impaired Subendocardial Wall Thickening and Post-Systolic Shortening Are Signs of Critical Myocardial Ischemia in Patients With Flow-Limiting Coronary Stenosis

Ishizu, Tomoko; Seo, Yoshihiro; Baba, Masakazu; Machino, Tomoko; Higuchi, Haruhiko; Shiotsuka, Junji; Noguchi, Yuichi; Aonuma, Kazutaka

doi:10.1253/circj.cj-10-1085

Cited by 27 publications

(27 citation statements)

References 38 publications

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“…10 In the present study, the presence of retinopathy was a significant determinant of LV longitudinal dysfunction in the hypertensive DM subgroup. Microvasculopathy in DM, in which reduced coronary microcirculation leads to chronic myocardial ischemia without the ability of compensatory angiogenesis, 20 may be a potential mechanism of longitudinal systolic dysfunction.…”

Section: Reproducibilitysupporting

confidence: 49%

“…ECG abnormalities, such as Q waves, ST-T changes, and negative T waves, or positive exercise ECG test results or LV wall motion abnormalities on echocardiography were con- (inner CS and outer CS, respectively). 10 In the apical 4-chamber view, longitudinal strain (LS) was measured at the endocardial border. All images were stored electronically, and LV strain was analyzed off-line with 2D speckle tracking software (2D Wall Motion Tracking, Toshiba Medical Systems Co).…”

Section: Standard Echocardiographymentioning

confidence: 99%

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Subendocardial Systolic Dysfunction in Asymptomatic Normotensive Diabetic Patients

Enomoto

Ishizu

Seo

et al. 2015

Circ J

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Background: It remains uncertain whether diabetes itself causes specific echocardiographic features of myocardial morphology and function in the absence of hypertension or ischemic heart disease. The purpose of the present study was to determine the characteristics of pure diabetic cardiomyopathy-related echocardiographic morphology and function using layer-by-layer evaluation with myocardial strain echocardiography. Methods and Results:We enrolled 104 patients with poorly controlled type 2 diabetes mellitus (mean HbA1c level, 10%) with (n=74) or without (n=40) hypertension and 24 age-and sex-matched healthy volunteers. Patients with coronary artery stenosis or structural heart disease were excluded. Myocardial layer-specific strain was analyzed by speckle tracking echocardiography. Compared with the healthy control group, the normotensive diabetes group showed no significant difference in ejection fraction, left ventricular mass index, diastolic properties, left atrial volume index, or B-type natriuretic protein (BNP) level, but global longitudinal strain and subendocardial radial strain were significantly deteriorated. The deterioration of longitudinal strain correlated with body mass index (R=0.49, P<0.01) and blood pressure (R=0.36, P<0.01) in the normotensive diabetes group. Conclusions:Deterioration of left ventricular longitudinal shortening accompanied by decreased subendocardial wall thickening are the characteristic functional abnormalities of diabetic cardiomyopathy in patients without hypertrophy, diastolic dysfunction, or elevated BNP. Obesity and blood pressure may also play important roles in this strain abnormality in asymptomatic patients with type 2 diabetes. (Circ J 2015; 79: 1749 -1755

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Section: Reproducibilitysupporting

confidence: 49%

Section: Standard Echocardiographymentioning

confidence: 99%

Subendocardial Systolic Dysfunction in Asymptomatic Normotensive Diabetic Patients

Enomoto

Ishizu

Seo

et al. 2015

Circ J

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“…The myocardium consists of 3 layers [7]. The orientation of subendocardial muscle fibers is longitudinal, so a LS decrease along with a reduction of inner myocardial wall thickening may document The absolute values of longitudinal (a) and circumferential (b) strains decreased progressively from endocardium, mid-myocardium to epicardium.…”

Section: Discussionmentioning

confidence: 99%

Layer-specific myocardial strain analysis: investigation of regional deformation in a rabbit model of diabetes mellitus during different stages.

Qiao

Zeng

et al. 2016

Med Ultrason

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Aim: The purpose of the present study was to determine the characteristics of myocardial damage at different stages of diabetes mellitus (DM) using layer-specific myocardial strain. Material and methods: Thirty six New Zealand white rabbits were randomly divided into either the control group (n =18) or the DM group (induced with alloxan) (n=18). For the myocardial deformation studies echocardiography and layer-specific strain were performed at baseline and after 3, 6, and 9 months in all of the rabbits. Three-layer longitudinal strain (LS) was calculated in the apical 4-chamber view, and three-layer circumferential strain (CS) in the short-axis view at the level of mitral valve. Layer-specific longitudinal and circumferential strains were assessed from endocardium, mid-myocardium and epicardium. For histomorphological study of the heart structure, the rabbits were sacrificed at 3, 6 and 9 months. Routine hematoxylin and eosin staining was performed. Results: The highest absolute values of left ventricular longitudinal strain (LS) and circumferential strain (CS) were registered in the endocardium and the lowest in the epicardium in both groups. At 3 months, there was no significant difference in three-layer LS and CS (p>0.05), but at 6 months the LS of endocardium (LSendo) and CS of endocardium (CSendo) were lower in the DM group compared with the control group; at 9 months, the rest of the parameters were also decreased (p<0.05). Moreover, in ROC analysis at 6 months LSendo yielded better sensitivity and specificity in the detection of diabetic cardiomyopathy (AUC of LSendo was 0.897 and AUC of CSendo was 0.617). With the progression of untreated diabetes, the histopathological abnormalities intensified gradually beginning at 6 months. Conclusion: The progressive impairments in LV myocardial deformation and structure occurs early in diabetic rabbits, the myocardial damage may be nontransmural, and endocardial function is more susceptible to be affected by DM. Layer-specific myocardial strain echocardiography may identify subtle myocardial dysfunction in the early stages of DM.

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“…Furthermore, longitudinal strain may be less sensitive to assess ischemia than other echocardiographic parameters. 25 …”

Section: Limitations Of Rv-2d Strain Measurementmentioning

confidence: 99%

Prognostic Significance and Normal Values of 2D Strain to Assess Right Ventricular Systolic Function in Chronic Heart Failure

Guendouz

Rappeneau

Nahum

et al. 2012

Circ J

114

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Background:Normal values and the prognostic significance of right ventricle (RV)-2D strain in chronic heart failure (CHF) patients are unknown. Methods and Results:Between 2005 and 2010, we prospectively enrolled 43 controls and 118 stable CHF patients. Standard echocardiographic variables, tricuspid annular plane systolic excursion, peak systolic velocity of tricuspid annular motion using tissue Doppler imaging, and RV and left ventricle (LV) 2D-strain were measured. The primary outcome was death or emergency transplantation or emergency ventricular assist device implantation or acute heart failure. RV-2D strain was measurable in 39 controls (58±17 years, 50% men), whose median value was −30% (95% confidence interval [95%CI], −39%; −20%); and in 104 CHF patients (80% men, mean age 57±11 years, and mean LV ejection fraction 29%±8%), whose median value was −19% (95%CI, −34%; −9%). During the mean follow-up of 37±14 months, 44 experienced the primary outcome. By Cox proportional hazards multivariate analysis, only RV-2D strain and log B-type natriuretic peptide independently predicted experiencing the primary outcome within the first year. The best RV-2D strain cut-off by receiver-operating characteristics analysis was −21%, and patients with values >−21% were at greatest risk ( χ2 -log-rank test=14.1, P<0.0001).Conclusions: RV-2D strain is a strong independent predictor of severe adverse events in patients with CHF and may be superior to other systolic RV or LV echocardiographic variables. (Circ J 2012; 76: 127 - 136)

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Impaired Subendocardial Wall Thickening and Post-Systolic Shortening Are Signs of Critical Myocardial Ischemia in Patients With Flow-Limiting Coronary Stenosis

Cited by 27 publications

References 38 publications

Subendocardial Systolic Dysfunction in Asymptomatic Normotensive Diabetic Patients

Subendocardial Systolic Dysfunction in Asymptomatic Normotensive Diabetic Patients

Layer-specific myocardial strain analysis: investigation of regional deformation in a rabbit model of diabetes mellitus during different stages.

Prognostic Significance and Normal Values of 2D Strain to Assess Right Ventricular Systolic Function in Chronic Heart Failure

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