Relationship Between Regional and Global Left Ventricular Systolic and Diastolic Function in Patients With Coronary Artery Disease Assessed by Strain Rate Imaging

Abstract

lobal left ventricular systolic and diastolic functions in patients with coronary artery disease (CAD) are traditionally assessed as important clinical and prognostic parameters. Several studies have recently demonstrated, by using non-invasive techniques including echocardiography, magnetic resonance imaging and radionuclide ventriculography, that the assessment of regional myocardial function provides important diagnostic and prognostic information in addition to that provided by global assessment alone. [1][2][3][4][5][6] It has been shown that the indices of global left ventricular systolic and diastolic functions are associated with each other, but the relationship between regional myocardial contraction and relaxation remains unknown.Echocardiographic tissue Doppler strain rate (SR) imaging is a new means of information about regional myocardial function that uses tissue velocity data to calculate velocity gradients between 2 distinct points along an ultrasound beam. It is therefore theoretically less susceptible than tissue velocity imaging to cardiac translational motion and to myocardial tethering. Thus, SR imaging might be Circulation Journal Vol. 71, April 2007 able to analyze regional myocardial function more appropriately than tissue velocity imaging. [7][8][9][10][11] Wall motion score is a parameter of regional left ventricular systolic function and the wall motion score index, which is an average of wall motion scores among assessable segments, and correlates with left ventricular ejection fraction (LVEF). 12,13 In contrast, whether SR indices of regional myocardial function are associated with whole left ventricular function has not been clarified.The present study aimed to assess the relationship between regional myocardial systolic and diastolic function in patients with CAD using SR imaging. We also evaluated whether SR imaging findings of regional myocardial contraction and relaxation reflect global left ventricular systolic and early diastolic function, respectively. Methods Study PopulationFifty patients with CAD were eligible for recruitment into the present study. Patients with heart failure, valvular or congenital heart disease were excluded. All patients were successfully treated with a prior balloon angioplasty and intracoronary stenting, and had no ischemic myocardial segments defined as a reversible myocardial perfusion defect as indicated by exercise or adenosine triphosphate stress technetium-99m tetrofosmin single-photon emission computed tomography. Of these patients, 5 were excluded because of inadequate echocardiographic image quality.

Assessment of left and right atrial geometrical changes in patients with stable coronary artery disease: Left and right atrial strain and strain rate imaging study

“…During the cardiac cycle, the atria have three functions: reservoir, conduit and active contractile function. 4 Recently, several studies have shown that strain (S) and strain rates (SR) are powerful parameters of deformation; they directly reflect both global and regional systolic and diastolic myocardial function, 5 , 6 and can detect any early effects of CAD on LA functions. 7 The atrial reservoir function is reflected by systolic strain and strain rates, and the conduit and contractile functions are reflected by the early and late diastolic strain rate respectively.…”

Left Atrial and Right Atrial Deformation in Patients with Coronary Artery Disease: A Velocity Vector Imaging-Based Study

“…In recent years, accumulative evidence has shown that strain (ε) and strain rate (SR) are powerful echocardiographic parameters to directly reflect global and regional systolic and diastolic myocardial deformation [4]–[8], and to sensitively detect dysfunction from myocardial ischemia in CAD patients [9]–[12]. The measurement of atrial deformation by strain method is a promising and useful tool, but there are few data on the ischemia-related alterations of atrial myocardial deformation.…”

Prognostic Implications of the NT-ProBNP Level and Left Atrial Size in Non-Ischemic Dilated Cardiomyopathy

“…The lack of predictability of TDI leads to the suggestion that TDI would reflect primarily systolic dysfunction caused by ischemic heart diseases rather than non-ischemic diseases, although there would be a significant correlation or inter-relationship between systolic (S') and diastolic (E' and A') TDI of mitral annulus caused by the close physiologic interaction between systolic shortening and diastolic lengthening. 28,29 Similarly, in a previous study, 21 with regards to comparing the prognostic impact of echocardiographic factors against NT-ProBNP in CHF with systolic dysfunction, although it was not all the nonischemic etiology of CHF, the NT-ProBNP level provided the most informative predictor of outcome by multivariate analysis more than the E/E' ratio or restrictive filling patterns.…”