Postsystolic Shortening in Ischemic Myocardium

Skulstad, Helge; Edvardsen, Thor; Urheim, Stig; Rabben, Stein Inge; Stugaard, Marie; Lyseggen, Erik; Ihlen, Halfdan; Smiseth, Otto A.

doi:10.1161/01.cir.0000024102.55150.b6

Cited by 225 publications

(161 citation statements)

References 24 publications

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“…pulmonary valve) [51]. It is a well described phenomenon in both ischemic-and non-ischemic cardiomyopathies [51][52][53]. The exact mechanism of PSS is unclear.…”

Section: Deformation After Pulmonary Valve Closurementioning

confidence: 99%

Current and future role of echocardiography in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Mast

Teske²,

Doevendans³

2015

Cardiol J

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“…pulmonary valve) [51]. It is a well described phenomenon in both ischemic-and non-ischemic cardiomyopathies [51][52][53]. The exact mechanism of PSS is unclear.…”

Section: Deformation After Pulmonary Valve Closurementioning

confidence: 99%

Current and future role of echocardiography in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Mast

Teske²,

Doevendans³

2015

Cardiol J

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“…The mechanisms of postsystolic shortening were investigated by Skulstad et al (9), and it was found that postsystolic shortening was a relatively nonspecific feature of the ischemic myocardium. It could occur in severely ischemic myocardium by an entirely passive process, then representing passive recoil of dyskinetic segments.…”

Section: Apical Flow Reversal: Diagnostic Implicationsmentioning

confidence: 99%

Postsystolic shortening of ischemic myocardium: a mechanism of abnormal intraventricular filling

Urheim¹,

Edvardsen²,

Steine³

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

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Acute myocardial ischemia has been associated with abnormal filling patterns in the left ventricular (LV) apex. We hypothesized that this may in part be due to postsystolic shortening of ischemic apical segments, which leads to reversal of early diastolic apical flow. Fourteen open-chest anesthetized dogs were instrumented with micromanometers in the LV apex and left atrium and myocardial sonomicrometers in the anterior apical LV wall. Intraventricular filling by color Doppler and wall motion by strain Doppler echocardiography (SDE) were assessed from an apical view. Measurements were taken before and after 5 min of left anterior descending coronary artery (LAD) occlusion. In four dogs, we measured the pressure difference between the LV apex and outflow tract. At baseline, peak early diastolic flow velocities in the distal one-third of the LV were directed toward apex (9.2 Ϯ 1.6 cm/s). After LAD occlusion, the velocities reversed (Ϫ2.3 Ϯ 0.4 cm/s, P Ͻ 0.01), indicating that blood was ejected from the apex toward the base during early filling. This interpretation was confirmed by wall motion analysis, which showed postsystolic shortening of apical myocardial segments. The postsystolic shortening represented 9.7 Ϯ 1.7% (P Ͻ 0.01) and 14.2 Ϯ 2.4% (P Ͻ 0.01) of end-diastolic segment length by SDE and sonomicrometry, respectively. Consistent with the velocity changes, we found reversal of the early diastolic pressure gradient from the LV apex to outflow tract. In the present model, acute LAD occlusion resulted in reversal of early diastolic apical flow, and this was attributed to postsystolic shortening of dyskinetic apical segments. The clinical diagnostic importance of this finding remains to be determined. strain-Doppler echocardiography; two-dimensional color Doppler; myocardial ischemia; diastolic filling ASSESSMENT OF LEFT VENTRICULAR (LV) intracavitary filling by Doppler echocardiography is one of several noninvasive approaches for studying LV diastolic function. In the normal LV, the initial intraventricular filling wave propagates rapidly toward the apex, and, as demonstrated by color M-mode Doppler, there is near simultaneous onset of filling velocities along the entire LV inflow tract (7). However, in patients with reduced LV ejection fraction or impaired diastolic function, the early diastolic apical filling may be markedly delayed, and this can be measured as slowing of mitral-to-apical flow propagation (1, 13). This has been attributed to a decrease in rate of LV relaxation, which causes a decrease in the driving pressure for mitral-to-apical flow (1, 12, 13), to loss of "apical suction" (12), and enhanced vortex formations due to changes in LV and mitral valve geometry (10).There is, however, very limited insight into how regional wall motion interacts with intraventricular flow. A common finding in ischemic myocardium is postsystolic (postejection) shortening and consequently delayed onset of diastolic lengthening (8,16,17). Therefore, in the ischemic ventricle, there may be substantial regional async...

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“…[3][4][5][6][7][8][9][10] It is frequently observed in patients with CAD presenting with LV asynergy. [23][24][25] Earlier studies have demonstrated the presence of abnormal diastolic function in patients with CAD without evidence of systolic wall motion abnormalities by radionuclide angiography or digitized cineangiography.…”

Section: Discussionmentioning

confidence: 99%

“…Both clinical [3][4][5] and animal studies [6][7][8][9][10] have demonstrated that PSS is related to myocardial ischemia.…”

Section: Editorial P 37mentioning

confidence: 99%

“…10 Positive VIR was defined as an upward spike between the end of the systolic ejection phase and the onset of the early diastolic relaxation phase that lasted longer than 100 ms. We determined whether positive VIR was present on the spectral TDI tracings. CAD was considered present if positive VIR was present in 1 or more of the 8 points in each subject.…”

Section: Mapping Of Myocardial Velocity Imaging (Momi)mentioning

confidence: 99%

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Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion

Onishi

Uematsu

Nanto

et al. 2009

Circ J

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Background Post-systolic shortening (PSS) is a sensitive indicator of myocardial ischemia. Methods and ResultsWe have developed a tissue Doppler imaging technique that portrays PSS, and whether PSS correlates with coronary artery disease (CAD) was investigated in 186 patients presenting with chest pain and normal echocardiograms. Delays of the displacement peaks from end-systole were calculated in the apical views and displayed from green (0 ms) to red (≥100 ms): detection of diastolic abnormality by dyssynchrony imaging (DADI). CAD was judged positive by DADI when the left ventricular segments were color-coded red. Patients subsequently underwent thallium-201 myocardial perfusion single-photon emission computed tomography (n=150), coronary angiography (CAG, n=74), or both (n=37). CAD(-) was defined as negative scintigraphy test and/or no significant coronary artery stenosis by CAG. In 43 patients (23%), CAD(+) was confirmed by CAG as >75% diameter stenosis. DADI predicted CAD with sensitivity of 60%, specificity of 75%, predictive accuracy of 72%, positive predictive value of 42%, and negative predictive value of 86%. Among 74 patients who underwent CAG, sensitivity was best for the left anterior descending artery. Conclusions DADI detected the regional diastolic abnormality, which correlated with the presence of CAD in patients presenting with visibly normal wall motion. (Circ J 2009; 73: 125 -131)

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Postsystolic Shortening in Ischemic Myocardium

Cited by 225 publications

References 24 publications

Current and future role of echocardiography in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Current and future role of echocardiography in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Postsystolic shortening of ischemic myocardium: a mechanism of abnormal intraventricular filling

Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion

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