OBJECTIVES: The aim of this study was to define an index that can differentiate normal from ischemic myocardial segments that exhibit postsystolic shortening (PSS). BACKGROUND: Identification of ischemia based on the reduction of regional systolic function is sometimes challenging because other factors such as normal nonuniformity in contraction between segments, tethering effect, pharmacologic agents, or alterations in loading conditions can also cause reduction in regional systolic deformation. The PSS (contraction after the end of systole) is a sensitive marker of ischemia; however, inconsistent patterns have also been observed in presumed normal myocardium. METHODS: Twenty-eight open-chest pigs underwent echocardiographic study before and during acute myocardial ischemia induced by coronary artery occlusion. Ultrasound-derived myocardial longitudinal strain rates were calculated during systole (SSR), isovolumic relaxation (IVRSR), and rapid filling (ESR) phases in both ischemic and normal myocardium. Systolic strain (εsys) and postsystolic strain (εps) were calculated by integrating systolic and postsystolic strain rates, respectively. RESULTS: During ischemia, SSR, ESR, and εsys in ischemic segments were significantly lower (in magnitude) than in nonischemic segments or at baseline. However, some overlap occurred between ischemic and normal values for all three parameters. At baseline, 18 of 28 animals had negative IVRSR (i.e., PSS) in at least one segment. During coronary artery occlusion, IVRSR became negative and larger in magnitude than SSR in all ischemic segments. The IVRSR/SSR and εps best differentiated ischemic from nonischemic segments. CONCLUSIONS: In the presence of reduced regional systolic deformation, a higher rate of PSS than systolic shortening identifies acutely ischemic myocardium.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine