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CLINICAL RESEARCH: CARDIAC IMAGING

Exercise-Induced Post-Ischemic Left Ventricular Delayed Relaxation or Diastolic Stunning

Is it a Reliable Marker in Detecting Coronary Artery Disease?

Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan

Manuscript received July 7, 2008; revised manuscript received August 25, 2008, accepted September 8, 2008.

^_* Reprint requests and correspondence: Dr. Katsuhisa Ishii, Department of Cardiology, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka 553-0003, Japan (Email: ishii.katsuhisa{at}b2.kepco.co.jp).

Objectives: The aim of this study was to determine whether post-ischemic left ventricular (LV) delayed relaxation could be detected by using strain imaging (SI) derived from 2-dimensional speckle-tracking echocardiography in patients with stable effort angina.

Background: Regional LV delayed relaxation during early diastole is a sensitive sign of acute myocardial ischemia and may persist beyond recovery of exercise-induced ischemia.

Methods: Regional LV transverse strain changes during the first one-third of diastole duration (strain imaging diastolic index [SI-DI]) were determined at baseline and 5 and 10 min after the exercise test in 162 patients with stable effort angina. The ratio of SI-DI before and after exercise (SI-DI ratio) was used to identify regional LV delayed relaxation.

Results: A total of 117 patients had significant (50% of luminal diameter) coronary stenoses. The mean SI-DI decreased from 78.0 ± 9.7% to 27.6 ± 16.0% (p < 0.0001) in 191 territories perfused by coronary arteries with significant stenoses 5 min after the treadmill exercise, whereas it remained unchanged in 280 territories perfused by arteries with nonsignificant stenoses. Ten minutes after exercise, regional delayed relaxation was still observed in 85% of territories perfused by stenotic coronary arteries. An SI-DI ratio with a cutoff value of 0.74 had a sensitivity of 97% and a specificity of 93% to detect significant coronary stenosis in the receiver-operator characteristic curve.

Conclusions: Detection of post-ischemic regional LV delayed relaxation or diastolic stunning after treadmill exercise using SI is a sensitive and reliable method for the detection of coronary artery disease.

Key Words: 2D speckle tracking echocardiography • post-ischemic delayed relaxation • diastolic stunning • exercise stress test • effort angina

Abbreviations and Acronyms   2D = two-dimensional   CAD = coronary artery disease   LV = left ventricle   SI = strain imaging   SI-DI = strain imaging diastolic index

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