Detection of Postischemic Regional Left Ventricular Delayed Outward Wall Motion or Diastolic Stunning After Exercise-induced Ischemia in Patients with Stable Effort Angina by Using Color Kinesis

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To determine whether postischemic diastolic stunning could be detected using color kinesis, we evaluated regional left ventricular (LV) diastolic wall motion in 36 patients with stable effort angina and a coronary stenosis (≥70% of luminal diameter), and in 30 control subjects. Regional LV filling fraction in the short-axis view during the first 30% of the LV filling time (color kinesis diastolic index) was determined before, 20 minutes, 1 hour, and 24 hours after the treadmill exercise test. In 33 of the 36 patients (92%), new regional LV delayed outward motion during early diastole (color kinesis diastolic index ≤ 40%) was detected at 20 minutes after exercise. The regional LV delayed diastolic wall motion showed significant improvement but persisted 1 hour afterward in 20 of 36 patients (56%), and disappeared 24 hours after exercise. Detection of regional stunned myocardium with impaired diastolic function may be a useful tool for the diagnosis of coronary artery disease.

Section snippets

Study Patients

Six patients with poor echocardiographic acoustic windows or inadequate endocardial tracking in all segments by CK8 were excluded from a group of 42 consecutive patients who had Canadian Cardiovascular Society Classification II10 stable effort angina with a significant coronary stenosis (≥70% of luminal diameter) in the major epicardial coronary arteries on coronary angiography. Thus, the study population consisted of 36 patients (28 men and 8 women with a mean age of 64 ± 8 years; range: 43-79

Regional LV Diastolic Wall Motion Evaluated by CK Before and After the Exercise Test

Baseline characteristics of all patients are listed in Table. Of 36 patients, there was significant LAD stenosis in 20, circumflex artery stenosis in 8, and right coronary artery stenosis in 8 patients. Mean stenosis severity by quantitative coronary angiography was 78% ± 4.8% in the LAD, 77% ± 4.3% in left circumflex artery, and 80% ± 2.6% in the right coronary artery.

In the study patients, no abnormal regional diastolic delayed relaxation or diastolic asynchrony (CK diastolic index ≤ 40%) was

Postischemic Regional LV Delayed Outward Wall Motion During Diastole After Exercise-induced Myocardial Ischemia

In the current study regional LV delayed outward wall motion during diastole or diastolic asynchrony that probably developed during exercise was detected by the CK method both at 20 minutes and 1 hour after exercise-induced myocardial ischemia in patients with stable effort angina and coronary artery disease. Whereas no apparent systolic abnormalities were detected by conventional echocardiographic study either at baseline or 20 minutes after the exercise, the CK method was able to track and

Clinical Implications

In the current study regional relaxation was significantly prolonged in the involved coronary segments even 1 hour after the treadmill exercise test. In 4 study patients (11%), stress-induced regional systolic wall-motion abnormality was not detected; however, regional LV delayed relaxation was detected 20 minutes after the treadmill exercise test in these patients. Moreover, the CK diastolic index after the treadmill exercise test was highly accurate for identification of the involved coronary

Limitations

The current study has several limitations with regard to application of the results to the clinical setting. First, it remains undetermined how long the regional diastolic wall-motion abnormality actually persists after demand ischemia. The duration of the observed diastolic stunning after demand ischemia is probably influenced by the total ischemic burden during the treadmill exercise testing and the severity of the coronary stenosis and endothelial function in the microvessels of the regional

Conclusions

Exercise-induced regional myocardial ischemia impairs regional diastolic wall motion in patients with coronary artery disease, and this impairment persists even 1 hour after exercise, when normal regional systolic motion is completely restored. Echocardiographic evaluation of regional myocardial wall motion by CK after exercise is a useful noninvasive method for detection of prolonged postischemic diastolic dysfunction or stunning and for identification of the angina-provoking vessel in

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