Postsystolic Motion Research Articles

A Study of the Usefulness of Tissue Doppler Imaging for the Diagnosis of Coronary Artery Disease in Patients with Left Bundle Branch Block

Abstract Background: In patients with left bundle branch block (LBBB), the diagnosis of ischemia by noninvasive modalities is cumbersome. Most of them such as stress tests, nuclear imaging, and magnetic resonance imaging have limitations in the detection of ischemia in this subset. The postsystolic motion (PSM) during the isovolumetric relaxation period on tissue Doppler imaging (TDI) is a sensitive and specific marker of ischemia. We aimed to see whether the TDI parameters can detect coronary artery disease (CAD) in patients with LBBB. Materials and Methods: Patients with LBBB (n = 64) who underwent coronary angiography were divided into two groups. Group A (n = 30) included patients with left anterior descending (LAD) artery stenosis of ≥70%, and group B (n = 34) included patients without LAD stenosis. All patients underwent TDI and various myocardial tissue velocity parameters were analyzed to detect the presence of CAD. P < 0.05 was considered significant. Results: The TDI of the mid-interventricular septum showed a higher delayed amplitude of PSM (>100 ms after aortic valve closure), lower myocardial systolic (Sm), and early diastolic (Em) velocities, and a higher late diastolic (Am) velocity in group A when compared to group B (all were significant, P < 0.0001). Both the ratios Sm/PSM and Em/Am were significantly lower in group A compared to group B (P < 0.0001). On receiver operating characteristic curve analysis to predict the presence of significant LAD stenosis, the value of Sm/PSM ratio <0.8 showed the best combination of sensitivity (78%) and specificity (96%) with an area under the curve of 0.936. Conclusion: TDI, a noninvasive imaging modality, is reliable and effective in identifying myocardial ischemia in patients with LBBB.

Left Ventricle Phenotyping Utilizing Tissue Doppler Imaging in Premature Infants with Varying Severity of Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is characterized by alveolar-capillary simplification and is associated with pulmonary hypertension (PH) in preterm infants. The contribution of left ventricle (LV) disease towards this severe BPD-PH phenotype is not well established. We aimed to describe the longitudinal trajectory of the LV function as measured by tissue Doppler imaging (TDI) and its association with BPD-PH. We retrospectively assessed prospectively acquired clinical and echocardiographic data from 77 preterm infants born between 2011 and 2013. We characterized the LV function by measuring systolic and diastolic myocardial velocities (s’, e’, a’), isovolumetric relaxation time (IVRT), and myocardial performance index with TDI at three time periods from 32 and 36 weeks, postmenstrual age through one year of age. We also measured post systolic motion (PSM), a marker of myocardial dysfunction that results from asynchronous movement of the ventricular walls, and not previously described in preterm infants. Patients were stratified into groups according to BPD severity and the presence of PH and compared over time. Conventional TDI measures of the LV function were similar between groups, but the septal PSM was significantly prolonged over the first year of age in patients with BPD-PH. PSM provides a novel objective way to assess the hemodynamic impact of lung and pulmonary vascular disease severity on LV function in preterm infants with BPD and PH.

421 Exploring hypertensive patient profiles based on full myocardial deformation and Doppler traces - insights from a machine-learning approach

Abstract Funding Acknowledgements Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310) Background and aim Contemporary echocardiography provides complex data on cardiac function contained in both blood-pool and tissue deformation traces. Their current interpretation relies on clinical experience and selected peak or averaged velocity values, which might not capture the complexity throughout the cardiac cycle. The aim is to investigate if machine learning could recognize relevant patient profiles in arterial hypertension by integrating all echocardiographic data to better define potential pathophysiological changes in left ventricle (LV) remodeling. Methods An echocardiogram was performed in 100 patients with established arterial hypertension (> 3 years). Myocardial deformation traces of the LV and the left atrium (LA), assessed by 2D speckle tracking, the aortic outflow Doppler trace, the lateral and septal mitral annular Doppler velocity traces, and the mitral inflow Doppler trace were assessed as measures of cardiac function. An unsupervised machine learning algorithm (multiple kernel learning) was used to reduce the dimensionality of these data, and to position the patients based on the similarities of echocardiographic data. The main patterns of variability present in the data were interpreted through non-linear regression analysis. Classic echocardiographic parameters, measured by a clinician, were then compared between the intermediate and extreme patient profiles across the variability spectrum. Results Figure 1 shows differences in velocity and deformation traces between the three representative patient profiles. While at one end of the spectrum, all echocardiographic traces were normal (red and green), the data of the other extreme patient profile (blue) describes a characteristic and consistent LV pressure overload remodeling pattern, with slightly reduced and delayed aortic outflow velocities, fused E and A waves with the ratio < 1, lower e’ mitral annulus velocities, decreased basal septal strain with post-systolic motion, prolonged relaxation in early diastole as seen by the deformation traces, and a change in atrial deformation dynamic with augmentation of LA contractile strain. The clinical measurements concurred with the remodeling profile describing smaller end-diastolic LV diameter and end-systolic and end-diastolic LV volumes, a reduced E/A ratio and e’ medial annular velocity, reduced TAPSE and increased LA contractile strain. Conclusion Machine learning based assessment of complex echocardiographic data has the potential to recognize an integrated and comprehensive patient profile related to LV remodeling within the hypertensive cohort without relying on classical clinical measurements and parameters, but by learning from subtle differences globally present in velocity and deformation echocardiographic data. Abstract 421 Figure 1

PREDICTION OF CORONARY ARTERY DISEASE BY DETECTION OF POSITIVE ISOVOLUMIC RELAXATION VELOCITY IN PATIENTS WITH NORMAL RESTING WALL MOTIONS "A Tissue Doppler Echocardiographic Study"

Background: Diagnosis of coronary artery disease (CAD) is of importance in the contemporary society of ever-increasing CAD (1,2). Isovolumic relaxation velocity (VIR), Postsystolic motion or postsystolic shortening (PSS) is a delayed ejection motion of the myocardium occurring after the aortic valve closure during a generally prolonged isovolumic relaxation time, which is related with myocardial ischemia in human(3,4) and in experimental studies(5). Spectral tissue Doppler imaging (TDI) is a simple echocardiographic technique that can provide velocity measurement of the myocardial segments(6). A positive myocardial velocity during isovolumic relaxation phase (VIR) detected by TDI, which corresponds to postsystolic motion or PSS, has been shown to indicate severely ischemic myocardium(8). So, detection of positive VIR by spectral TDI may be used as a noninvasive, nonprovocative method to predict possible CAD; specially for those with coexisting morbidities, such as peripheral artery disease in the lower limb, orthopedic diseases. Aim of the work: Diagnostic value of positive myocardial velocity during isovolumic relaxation phase (VIR) by spectral TDI in prediction of CAD in patients with typical ischemic chest pain and normal resting wall motions. Patients and methods: This study was done in Cardiology department, Zagazig University on 80 patients; 41 females (51%) & 39 males (49%)) with typical ischemic chest pain and no regional wall motion abnormalities detected by resting echocardiography. Patients were divided into 2 groups according to presence of significant coronary artery lesion by coronary angiography; group A (patients with CAD) and group B (patients without CAD). All the following parameters were measured by TDI; 5 peak velocities during; Isovolumic contraction phase (VIC), Systolic ejection phase (S'), Early diastolic relaxation phase (Em), Atrial contraction phase (Am) and Isovolumic relaxation phase (VIR) if present and VIR time. Then coronary angiography was done for all patients. Results: As regard to presence of VIR velocity, there was significant difference (<0.05) between group A and group B at mid septal and anterior walls, highly significant difference (<0.001) at basal septal and anterior walls. There was highly significant difference between group A and B at mid and basal lateral and inferior walls. There was highly significant correlation between coronary angiography and VIR velocity regarding detection of positive and negative cases and also there was highly significant correlation between previous 2 tests by Kappa test p value (<0.001). Conclusion: Positive VIR detected by spectral tissue Doppler imaging is a useful indicator of CAD in patients with apparently normal left ventricular contraction and chest pain. Key words: TDI, VIR velocity, coronary angiofraphy, coronary artery disease.

Relationship Between Post-Systolic Motion During Dobutamine Stress Echocardiography and Functional Recovery of Myocardium After Successful Percutaneous Coronary Intervention

Background and ObjectivesDoppler myocardial imaging (DMI) has been suggested as a method of quantifying inducible ischemia during dobutamine stress echocardiography (DSE). Post-systolic motion (PSM) detected by DMI is related to peri-infarct ischemia during DSE. We hypothesized that PSM during DSE would predict recovery of dysfunctional myocardium after successful percutaneous coronary intervention (PCI).Subjects and MethodsThirty patients with dysfunctional myocardium in the left anterior descending coronary artery (LAD) territory were divided into two groups according to improvement of wall motion score index (WMSI) in the LAD territory at 6 months after successful PCI of the LAD. DMI was evaluated in the LAD territory during DSE. Fifteen patients showed improved WMSI (1.42±0.39) while the other 15 had unchanged WMSI (1.75±0.46) 1 month after PCI. Myocardial velocity was measured in the mid-septal, apico-septal, and basal anterior segments of the LAD artery territory. PSM was defined as a positive wave appearing after the curve of systolic ejection had reached the zero line.ResultsAlthough there was no difference between resting PSMs in both groups, PSM during DSE was significantly higher in the improved WMSI group than in the WMSI group where it was unchanged.ConclusionPSM during DSE predicts recovery of dysfunctional myocardium after successful PCI.

Does Postsystolic Motion or Shortening Predict Recovery of Myocardial Function After Primary Percutanous Coronary Intervention?

The purpose of the study was to evaluate whether presence of postsystolic motion or shortening defined by Doppler tissue imaging may predict recovery of regional myocardial function in patients with ST-elevation myocardial infarction. Echocardiography was performed a few hours after primary percutanous coronary intervention and at a 3-month follow-up visit in 83 patients with ST-elevation myocardial infarction. Based on visual assessment of wall thickening in a 16-segment model, segments were classified into those with: dyskinesia/akinesia (type A, n = 63) or hypokinesia (type B, n = 141) in the acute phase and no recovery of function at follow-up; dyskinesia/akinesia in the acute phase and partial recovery of function at follow-up (type C, n = 86); dyskinesia/akinesia/hypokinesia in the acute phase and complete recovery of function at follow-up (type D, n = 243); and normal myocardial function in the acute phase (type E, n = 759). There were no differences among type A, B, C, and D segments with regard to the proportion presenting postsystolic tissue velocity equal to or greater than 1.0 cm/s (0.52, 0.54, 0.60, and 0.47, respectively, P = .20) or with respect to postsystolic negative increase in strain (median -2.9, -1.9, -1.8, and -1.5%, respectively, P = .13) in the acute phase. However, type E segments less often presented postsystolic tissue velocity greater than 1.0 cm/s and presented lower postsystolic increase in strain (0.39 and -1.0%, respectively, P < .001 as compared with type A-D segments). In initially dysfunctional segments, presence of postsystolic contraction was not associated with improvement in strain or wall-motion score at follow-up. In patients with ST-elevation myocardial infarction postsystolic motion or shortening appears more frequently in the acute phase in myocardial segments with impaired systolic function compared with normally functioning segments. However, presence of postsystolic contraction is not associated with improvement in strain or wall-motion score at follow-up, and does not seem to be a marker of viability.

Post-systolic motion in patients with heart failure – A marker of left ventricular dyssynchrony?

The pathophysiology of post- systolic motion (PSM) is not yet fully resolved. Our aim was to study PSM in patients with heart failure (HF) and its relation to left ventricular (LV) function, brain natriuretic peptide (BNP) and to mortality. Forty seven HF patients, mean-age 75+/-8 years with LV ejection fraction (EF) 31+/-11% were studied prospectively and compared with 10 age-matched healthy controls. Doppler Tissue Imaging data were obtained in the basal 4-chamber segments of the septal wall and PSM were measured as the ratio between velocity time integral (vti) of the positive post-systolic and systolic motion. Mean septal wall PSM was increased 0.52+/-0.41 vs controls 0.05+/-0.07 (p<0.001) and abnormal PSM (>0.18) was detected in 79% of all HF patients (92% if QRS >130 ms). Septal wall PSM correlated with QRS-duration, LV volume indices, myocardial isovolumic relaxation time (IVRT(m)) and inversely with heart rate and diastolic blood pressure, but not with BNP levels or LVEF. Only IVRT(m) correlated independently with the PSM (R(2)=0.55, p<0.001). Seventeen patients died during a mean follow-up time of 30+/-18 months. The PSM value was similar in non-survivors and survivors, 0.53+/-0.45 vs 0.52+/-0.45 (ns). PSM is a common phenomenon in patients with HF especially in patients with wide QRS and long IVRT(m) suggesting that PSM is a manifestation of LV intra-ventricular dyssynchrony. In this study PSM did not predict mortality.

3139: May postsystolic motion during dobutamine stress echocardiography predict the functional recovery of dysfunctional myocardium after successful percutaneous coronary intervention?

Objectives: Doppler myocardial imaging (DMI) has been suggested as a method of quantifying induced ischemia during dobutamine stress echocardiography (DSE). Postsystolic motion (PSM) detected by DMI is related with peri-infarct ischemia at DSE. We hypothesized that PSM during DSE would predict functional recovery of dysfunctional myocardium after successful percutaneous coronary intervention (PCI).

175 May post-systolic motion during dobutamine stress echocardiography predict the functional recovery of dysfunctional myocardium after successful percutaneous coronary intervention?

175 May post-systolic motion during dobutamine stress echocardiography predict the functional recovery of dysfunctional myocardium after successful percutaneous coronary intervention?

176 Diagnostic potential of postsystolic motion index as a marker of stress induced symptomatic versus asymptomatic myocardial ischemia

176 Diagnostic potential of postsystolic motion index as a marker of stress induced symptomatic versus asymptomatic myocardial ischemia

Myocardial Postsystolic Motion in Ischemic and Not Ischemic Myocardium: The Clinical Value of Tissue Doppler

Postsystolic motion (PSM) is a delayed ejection motion of the myocardium occurring after the aortic valve closure, during a generally prolonged isovolumic relaxation time (IVRT). In this review we analyze the physiopathologic mechanisms underlying PSM and the contribution of tissue Doppler for its understanding. By using various techniques, this phenomenon has been described in experimental observations and related to myocardial ischemia produced by gradual or abrupt coronary occlusion. In clinical studies, it is associated with recovery of regional myocardial function. Tissue Doppler, providing a velocity map of myocardial motion, allows an easy, noninvasive detection of PSM in the clinical setting. PSM, as identified by tissue Doppler, appears a hallmark of myocardial ischemia and viability but it may occur also in nonischemic conditions as left ventricular (LV) hypertrophy and volume overload, left bundle branch block and even in normal individuals. Strain and strain rate (SR), obtainable by off-line color tissue Doppler, may be useful to identify the mechanisms underlying PSM since these measurements reflect, respectively, the intrinsic rate and the percentage of deformation of a given myocardial segment, and are relatively independent of both overall cardiac movement and tethering of the neighboring LV segments. By using SR imaging, the ratio of PSM to regional systolic longitudinal strain can be used to separate ischemic from nonischemic PSM and appears the best quantitative parameter to identify ischemia during dobutamine stress. A method to detect LV wall asynchrony and immediate benefit of cardiac resynchronization therapy has been developed combining the assessment of tissue-tracking (TT) derived delayed longitudinal contraction and of SR-derived PSM.

741 Apically directed postsystolic motion of the basal anteroseptal wall during stress-echo

741 Apically directed postsystolic motion of the basal anteroseptal wall during stress-echo

367 Apically directed post-systolic motion of the non-ischemic myocardium

367 Apically directed post-systolic motion of the non-ischemic myocardium