Ischemic Events During Coronary Artery Balloon Obstruction

Sigwart, Ulrich; Grbić, M; Payot, M; Goy, J.‐J.; Essinger, A; Fischer, Alfons

doi:10.1007/978-3-642-69589-6_6

Cited by 67 publications

(28 citation statements)

References 10 publications

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“…The onset of regional LV outward wall motion in the isovolumic relaxation phase has been reported to be delayed in the area perfused by the involved coronary artery. 3,5,11,12,19 The present study demonstrated that postischemic LV diastolic asynchrony detected by CK persisted but recovered to normal after a 4-week angina-free period in most of the study patients, possibly reflecting postischemic myocardial diastolic stunning. We have previously reported that this impairment usually persists for a few weeks after angina or ischemia -reperfusion in patients with coronary vasospasm blunting early diastolic regional wall motion.…”

Section: Discussionsupporting

confidence: 47%

Diagnosis of Multivessel Coronary Vasospasm by Detecting Postischemic Regional Left Ventricular Delayed Relaxation on Echocardiography Using Color Kinesis

Miwa

Ishii

Makita

et al. 2004

Circ J

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pisodes of coronary vasospasm are characterized by transient myocardial ischemia resulting from the temporary obstruction to coronary flow followed by reperfusion. Regional left ventricular (LV) diastolic dysfunction or delayed relaxation with prolonged isovolumic relaxation time may follow the transient, severe myocardial ischemia associated with coronary vasospasm and persist well beyond the recovery of the regional systolic dysfunction. 1-3 Color kinesis (CK) (Philips Medical Systems) is a new technique based on acoustic quantification that has been recently developed to facilitate the evaluation of regional wall motion (RWM). [4][5][6] Using this method we recently reported that impaired or stunned regional diastolic function after ischemia occurs commonly in patients with coronary vasospasm. 7,8 Okumura et al reported that in patients with variant angina (VA), intracoronary injection of acetylcholine (ACh) can induce spasm in each susceptible artery separately and that the incidence of multivessel coronary spasm is surprisingly high in these patients. 9 However, it is controversial whether multivessel coronary Circulation Journal Vol. 68, May 2004 spasm occurs spontaneously in these patients.The aim of the present study was to use CK to detect multiple sites of regional LV delayed endocardial wall motion during diastole to determine whether multivessel coronary spasm actually occurs spontaneously in patients with VA and demonstrated multivessel spasm induced by ACh. Methods Study PatientsOf 33 consecutive patients with VA in whom the inducibility of spasm of both the left and right coronary arteries was evaluated during cardiac catheterization, 7 who did not have good acoustic windows or adequate tracking by CK were excluded and the remaining 26 (19 men, 7 women; mean age, 62±9 years; range: 37-77 years) were the subjects of the present study. Electrocardiographic ST-segment elevation during at least an episode of angina was confirmed in all the patients. The CK study was performed within 1 week (3±2 days) prior to the coronary arteriography examination following a spontaneous angina attack. Patients with rhythm or conduction disturbances, a significant (>75% luminal diameter) organic coronary stenosis, apparent systolic regional LV dysfunction, LV hypertrophy or severe hypertension, were not included in the present study nor were patients without coronary spasm induced by ACh. In all patients coronary artery spasm Background It is not known whether multivessel coronary spasm occurs spontaneously in patients who have variant angina (VA) with demonstrated multivessel spasm induced by intracoronary injection of acetylcholine (ACh). Regional left ventricular (LV) diastolic dysfunction or wall motion abnormality may persist after an episode of coronary vasospasm. Color kinesis (CK) is a recent development that facilitates the echocardiographic evaluation of regional diastolic wall motion. Methods and ResultsRegional diastolic wall motion was evaluated using CK in 26 patients with VA within 1 week of the last...

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Section: Discussionsupporting

confidence: 47%

Diagnosis of Multivessel Coronary Vasospasm by Detecting Postischemic Regional Left Ventricular Delayed Relaxation on Echocardiography Using Color Kinesis

Miwa

Ishii

Makita

et al. 2004

Circ J

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“…[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.…”

mentioning

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

Circ J

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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...

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“…Visualization of a regional decrease in the systolic movement of the endocardium and a decrease in myocardial thickening are the main principles for the diagnosis of myocardial damage (Figure 1). In recent years, an ischemic cascade was suggested (Figure 2) [in the clinical setting, a test for coronary ischemia is not evident in any case what is caused by the different localization of collaterals (35)(36)(37)(38)]. …”

Section: Echocardiography In the Chronic And Acute Stages Of Chdmentioning

confidence: 99%

Echocardiographic assessment of myocardial ischemia

Leischik¹,

Dworrak²,

Sanchís-Gomar³

et al. 2016

Ann. Transl. Med.

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Over the last 60 years, echocardiography has emerged as a dominant and indispensable technique for the detection and assessment of coronary heart disease (CHD). In this review, we will describe and discuss this powerful tool of cardiology, especially in the hands of an experienced user, with a focus on myocardial ischemia.Technical development is still on-going, and various new ultrasound techniques have been established in the field of echocardiography in the last several years, including tissue Doppler imaging (TDI), contrast echocardiography, three-dimensional echocardiography (3DE), and speckle tracking echocardiography (i.e., strain/strain rateechocardiography). High-end equipment with harmonic imaging, high frame rates and the opportunity to adjust mechanical indices has improved imaging quality. Like all new techniques, these techniques must first be subjected to comprehensive scientific assessment, and appropriate training that accounts for physical and physiological limits should be provided. These limits will constantly be redefined as echocardiographic techniques continue to change, which will present new challenges for the further development of ultrasound technology.

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Ischemic Events During Coronary Artery Balloon Obstruction

Cited by 67 publications

References 10 publications

Diagnosis of Multivessel Coronary Vasospasm by Detecting Postischemic Regional Left Ventricular Delayed Relaxation on Echocardiography Using Color Kinesis

Diagnosis of Multivessel Coronary Vasospasm by Detecting Postischemic Regional Left Ventricular Delayed Relaxation on Echocardiography Using Color Kinesis

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

Echocardiographic assessment of myocardial ischemia

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