Abnormal Regional Left Ventricular Systolic and Diastolic Function in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: Clinical Significance of Post-Ischemic Diastolic Stunning

• Published in: Journal of the American College of Cardiology Vol. 54; no. 17; pp. 1589 - 1597
• Main Authors: ISHII, Katsuhisa, SUYAMA, Tamaki, IMAI, Makoto, MAENAKA, Motoyoshi, YAMANAKA, Asuka, MAKINO, Yasunaka, SEINO, Yutaka, SHIMADA, Kenei, YOSHIKAWA, Junichi
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 20-10-2009; Elsevier Limited
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Coronary Artery Disease - complications; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary heart disease; Coronary Occlusion - complications; Coronary Occlusion - physiopathology; Coronary Occlusion - therapy; Coronary vessels; Diastole; Diseases of the cardiovascular system; Female; Heart; Heart attacks; Humans; Intubation; Ischemia; Male; Medical sciences; Middle Aged; Myocardial Stunning - diagnostic imaging; Myocardial Stunning - etiology; Myocardial Stunning - physiopathology; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Software; Systole; Ultrasonography; Values; Variance analysis; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Human; Atherectomy; Angioplasty; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Regional; Coronary heart disease; Stent; Percutaneous route; Stunning; Ischemia; Circulatory system; Cardiology; Left ventricle performance
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.06.030

This study was designed to characterize both regional left ventricular (LV) systolic and diastolic function after percutaneous coronary intervention by using strain imaging (SI) derived from 2-dimensional speckle-tracking echocardiography.
Ischemic insult after coronary occlusion affects not only regional LV systolic but also diastolic function.
Regional LV transverse peak strain and strain changes during the first one-third of diastole duration (strain imaging diastolic index [SI-DI]) were monitored in at-risk segments after percutaneous coronary intervention in 30 patients with coronary artery disease. The segments were divided into proximal and distal. Strain data in the at-risk segments were compared with values derived from remote nonischemic segments.
Coronary occlusion induced a marked reduction in the systolic strain in both proximal and distal at-risk segments (from 36.9 +/- 6.0% to 12.0 +/- 3.9% and from 31.9 +/- 5.6% to 6.2 +/- 3.3%, respectively, p < 0.0001). Concomitantly, SI-DI values decreased (from 76.6 +/- 5.3% to -21.2 +/- 9.1% and from 72.5 +/- 5.9% to -48.7 +/- 20.8%, respectively, p < 0.0001). Upon reperfusion, systolic deformation parameters returned to near-normal pre-occlusion values. However, SI-DI values in the both proximal and distal at-risk segments decreased (43.2 +/- 9.5%, p < 0.01, and -17.3 +/- 11.1%, p < 0.0001, respectively) 30 min after reperfusion and were still lower (51.5 +/- 9.9%, p < 0.01) in the distal at-risk segment 24 h after reperfusion.
SI analysis provides detailed mechanical characterization of regions with myocardial ischemic insult and can demonstrate post-ischemic diastolic stunning despite complete systolic functional recovery after reperfusion.