Presence Of Postsystolic Shortening Research Articles

Usefulness of Postsystolic Shortening to Diagnose Coronary Artery Disease and Predict Future Cardiovascular Events in Stable Angina Pectoris

Postsystolic shortening (PSS) may occur during myocardial ischemia. We aimed to assess the diagnostic and prognostic potential of PSS in patients with suspected stable angina pectoris (SAP). This is a prospective study of patients with suspected SAP (N=293), no prior cardiac history, and normal ejection fraction, who were examined by speckle-tracking echocardiography, coronary angiography, and exercise electrocardiogram. We excluded patients with known heart disease (ischemia, heart failure, valve disease), bundle branch block, pathological Q-waves, and arrhythmias. PSS was assessed using the postsystolic index (PSI), and categorical presence of PSS was defined as PSI≥20% in one myocardial wall. The primary end point was major adverse cardiovascular events (MACEs), a composite of incident heart failure, myocardial infarction, and stroke. The secondary end point was MACE and revascularization (percutaneous coronary intervention/coronary artery bypass graft). A stenosis ≥70% in one or more coronary arteries defined significant coronary artery disease (CAD; n=107). Patients with significant CAD had a higher prevalence of PSS (55% vs 39%; P<.002), and presence of PSS was an independent predictor of significant CAD in multivariable models adjusted for clinical data, exercise test, and echocardiographic measures (odds ratio, 2.45; 95% CI, 1.08-5.60; P=.033). The PSI confirmed this association (odds ratio, 1.71; 95% CI, 1.04-2.82; P=.034 per 1% increase). During median follow-up of 3.5years (interquartile range, 2.7, 4.1) a total of 25 patients (8.5%) experienced MACE and 46 (15.7%) had the secondary end point. Presence of PSS was a predictor of MACE (hazard ratio, 2.57; 95% CI, 1.12-5.95; P=.028), and the association remained significant in adjusted models. Both presence of PSS and PSI were independent predictors of the secondary end point. In patients with suspected SAP, presence of PSS provides independent diagnostic information on significant CAD and offers novel prognostic information regarding risk of future cardiovascular events.

Presence of post-systolic shortening is an independent predictor of heart failure in patients following ST-segment elevation myocardial infarction.

Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primarypercutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow-up. A total of 373 patients admitted with STEMI and treated with pPCI were prospectively included in the study cohort. All patients were examined by echocardiography a median of 2days after admission (interquartile range, 1-3days). PSS was measured by color tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4years (interquartile range, 4.1-6.0years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex, peak troponin, left ventricle ejection fraction, TIMI flow grade, left ventricle mass index, hypertension and diabetes, presence of PSS by TDI in the culprit region was associated with a nearly twofold increased risk of HF (HR 1.90, 95% CI 1.02-3.53, P = 0.043) and the risk of HF increased incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09-1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95% CI 1.08-2.92, P = 0.024). Presence of PSS was not associated with increased risk of death or MI. In patients with STEMI treated with pPCI, the presence of PSS examined by TDI and STE provides prognostic information on development of HF. Presence of PSS in the septal wallis the strongest predictor of HF.

Global and regional myocardial function quantification by two-dimensional strain in Takotsubo cardiomyopathy

This study sought to characterize global and regional systolic function in Takotsubo cardiomyopathy (TC) using two-dimensional (2D) strain imaging. Twelve consecutive patients (11 women, 1 man) underwent 2D echocardiography on admission and on early follow-up (34 +/- 16 days). Two-dimensional images were analysed to measure longitudinal and radial strain and to calculate post-systolic shortening (PSS) and the post-systolic index (PSI). Mean age was 64 +/- 14 years. Upon presentation ejection fraction, average longitudinal and radial strains were 42 +/- 9%, -10.6 +/- 5.5%, and 20.1 +/- 17.3%, respectively. Values improved to 59 +/- 8%, -17.6 +/- 3.0%, and 50.2 +/- 17.0%, respectively (all P < 0.001). PSS was present in 69% of segments upon presentation and in 53% of segments upon follow-up. PSI was -0.16 at baseline and improved to -0.06 upon follow-up (P < 0.001). Patients with TC show abnormal global and regional strain patterns during the acute phase of the disease which improve over time. However, subtle abnormalities of regional LV function seem to persist into the early follow-up period as suggested by the presence of PSS in more than half of LV segments. Long-term follow-up studies are needed to clarify whether these subtle abnormalities will further improve.

P-105 Impact of Left Atrial Remodeling After Successful Mitral Ballon Valvuloplasty on Long-Term Clinical Outcome

Objective: Left ventricular postsystolic shortening (PSS) has been observed in dysfunctional myocardium as well as in normal subjects. Doppler echocardiographic features have been proposed to differentiate between normal and pathologic PSS. We studied the prevalence and characteristics of PSS in normal subjects, hypertension with left ventricular hypertrophy and ischemic heart disease (IHD) using Strain Imaging. Method: Strain Imaging parameters including peak systolic strain, magnitude of postsystolic strain and time to peak postsystolic strain were obtained for each left ventricular segment. Each group comprises 20 subjects (320 segments in normal group, 320 in hypertension and 126 in IHD group). For IHD, only segments with systolic wall motion abnormalities were studied. Results: PSS was present in 28% of segments in the normal group, 43% in hypertension group and 72% in ischemic group. Peak systolic strain was significantly lower in the ischemic group ( 9.4%) compared with hypertensive ( 15.8%) and normal ( 17.5%) groups. Postsystolic strain was higher in the ischemic ( 4.3%) and hypertension ( 3.7%) than in the normal group ( 1.6%). Time to peak systolic strain was significantly longer in the ischemic group (118ms) compared to the hypertension group (86ms) and normal group (69ms). Conclusion: Presence of PSS in hypertension is characterised by a higher magnitude than in normal subjects and is likely to reflect myocardial dysfunction. However, it may be distinguished from PSS in IHD by shorter time to peak postsystolic strain and higher peak systolic strain.

Abstract 4228: Objective Judgment in Dobutamine Stress Echocardiography: Visualization of Post-Systolic Shortening by Tissue Doppler Imaging

Background: Although dobutamine stress echocardiography (DSE) is widely used for the detection of coronary artery disease (CAD), interpretation requires expertise. Post-systolic shortening (PSS) is a sensitive maker of myocardial ischemia. We have developed a novel tissue Doppler imaging (TDI) technique that readily visualizes the presence of PSS on 2-dimensional echocardiograms, and investigated whether CAD is objectively detectable by using this technique during DSE. Methods: Detection of diastolic abnormality by displacement Imaging (DADI): PSS was detected by using tissue Doppler displacement timing analysis. In this method, end-systole was automatically determined from tissue velocity, and delays of the displacement peaks from the end-systole were displayed from green to red on the left ventricular apical views, depending on the preset time window. DSE was performed in consecutive 51 patients prior to coronary angiography (CAG) who underwent diagnostic CAG for suspected CAD, and presented with normal LV wall motion at rest (male=31, age ranged 44 – 83 years). We measured the time from the end-systole to displacement peak (ΔT) at each segment in the apical, mid and basal segments by the standard apical plane (long axis, 4 chamber and 2 chamber views). The optimal cut-off value of ΔT for discriminating normal from CAD was determined by receiver operating characteristic analysis. Finally, DADI was performed using the optimal ΔT. CAD was confirmed by CAG as having &gt;75% diameter stenosis. Results: Angiographic CAD was present in 31 patients (61%). DADI predicted CAD with sensitivity of 87%, specificity of 75%, negative predictive value of 79%, and predictive accuracy of 82% at the cut-ff ΔT of 80 ms at peak DSE. Conclusion: DADI was useful in making objective judgment in DSE by readily portraying the presence of PSS, a marker of myocardial ischemia, on 2-dimensional echocardiograms in patients with inducible myocardial ischemia.

Is Post-Systolic Shortening a Reliable Indicator of Myocardial Viability? An MR Tagging and Late-Enhancement Study

In ischemic myocardium systolic strain is reduced and followed by a deformation after systole, the so-called post-systolic shortening. The presence of post systolic shortening is therefore considered a marker of viability even though its mechanism remains unclear. The hypothesis was tested whether post-systolic shortening might be a passive recoil phenomenon and therefore not uniquely associated with viability. Five patients with a history of myocardial infarctions and fully transmural scars in late enhancement imaging and five age-matched healthy volunteers underwent a tagging study to analyze systolic and post-systolic deformation in transmurally infarcted and contra-lateral non-infarcted myocardium. From CSPAMM myocardial tagging data, mid-wall circumferential fiber shortening, radial displacement, and rotation parameters were semi-automatically extracted by harmonic phase (HARP). In transmurally infarcted myocardium, a post systolic shortening of 6.2 +/- 1.8% was present occurring in early diastole (time to maximum circumferential fiber shortening increased versus both, contralateral myocardium and corresponding sectors in healthy volunteers, p < 0.01). Maximum radial displacement was decreased in scar tissue (p < 0.001 versus contra-lateral), but time to maximum radial displacement did not differ. Rotation did not discriminate between infarcted and non-infarcted myocardium. The pure finding of post-systolic shortening is not sufficient for the diagnosis of residual myocardial viability. Post-systolic shortening may be explained in part by passive recoil, which releases energy stored in the scar tissue during systolic intra-ventricular unloading. Circumferential fiber shortening appears best suited for characterization of regional deformation, whereas radial displacement and rotation are more dependent on tethering effects, and thus, are more likely to reflect global chamber mechanics.