Correlation between post-ejection shortening and improvement in regional wall motion after revascularization in patients with coronary artery disease

Abstract

This study investigates the relationship between regional post-ejection shortening and improvement in wall motion after revascularization in patients with severe regional left ventricular contractile dysfunction. Canine studies have documented the phenomenon of post-systolic shortening during acute ischemia, and this predicted recovery of contractile function when ischemia was relieved. This delayed shortening from the ischemic segment would cause regional emptying while the other normal portion of the left ventricle starts to have diastolic relaxation. This was detectable by standard phase analysis of the radionuclide ventriculogram, the abnormal region with delayed emptying being distinguished from the normal portion of left ventricle as an area with a homogeneous phase delay. Twelve patients with successful revascularization and a pre-operative study demonstrating a single homogeneous area of phase delay were identified. The area was demarcated and the regional volume-time curve constructed. The volume-time curve of the abnormal region is analogous to the myocardial segment length versus time relationship in the canine model. We quantitated the amount of delayed (post-systolic) emptying in the demarcated region as the difference between end-systole counts and post-systolic nadir counts, and this was normalised to left ventricular stroke count. After revascularization, regional ejection fraction improved from 44 ± 10% to 62 ± 14% ( P < 0.001), representing a 47 ± 50% improvement over baseline. The percentage improvement in regional ejection fraction correlated with post-systolic emptying ( r = 0.74, P < 0.05) but not with initial regional ejection fraction. In conclusion, post-ejection shortening causes regional post-systolic emptying and this correlates with post-revascularization improvement in regional wall motion.