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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Abnormal Regional Left Ventricular Systolic and Diastolic Function in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Clinical Significance of Post-Ischemic Diastolic Stunning

Katsuhisa Ishii, MD^_*,_*, Tamaki Suyama, MD^_*, Makoto Imai, MD^_*, Motoyoshi Maenaka, MD^_*, Asuka Yamanaka, MD^_*, Yasunaka Makino, MD^_*, Yutaka Seino, MD^_*, Kenei Shimada, MD and Junichi Yoshikawa, MD

^_* Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
Department of Cardiology, Osaka Ekisaikai Hospital, Osaka Hospital of Japan Seafarers Relief Association, Osaka, Japan

Manuscript received March 13, 2009; revised manuscript received May 11, 2009, accepted June 1, 2009.

^_* 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: This study was designed to characterize both regional left ventricular (LV) systolic and diastolic function after percutaneous coronary intervention by using strain imaging (SI) derived from 2-dimensional speckle-tracking echocardiography.

Background: Ischemic insult after coronary occlusion affects not only regional LV systolic but also diastolic function.

Methods: Regional LV transverse peak strain and strain changes during the first one-third of diastole duration (strain imaging diastolic index [SI-DI]) were monitored in at-risk segments after percutaneous coronary intervention in 30 patients with coronary artery disease. The segments were divided into proximal and distal. Strain data in the at-risk segments were compared with values derived from remote nonischemic segments.

Results: Coronary occlusion induced a marked reduction in the systolic strain in both proximal and distal at-risk segments (from 36.9 ± 6.0% to 12.0 ± 3.9% and from 31.9 ± 5.6% to 6.2 ± 3.3%, respectively, p < 0.0001). Concomitantly, SI-DI values decreased (from 76.6 ± 5.3% to –21.2 ± 9.1% and from 72.5 ± 5.9% to –48.7 ± 20.8%, respectively, p < 0.0001). Upon reperfusion, systolic deformation parameters returned to near-normal pre-occlusion values. However, SI-DI values in the both proximal and distal at-risk segments decreased (43.2 ± 9.5%, p < 0.01, and –17.3 ± 11.1%, p < 0.0001, respectively) 30 min after reperfusion and were still lower (51.5 ± 9.9%, p < 0.01) in the distal at-risk segment 24 h after reperfusion.

Conclusions: SI analysis provides detailed mechanical characterization of regions with myocardial ischemic insult and can demonstrate post-ischemic diastolic stunning despite complete systolic functional recovery after reperfusion.

Key Words: 2-dimensional speckle-tracking echocardiography • coronary artery disease • percutaneous coronary intervention • post-ischemic diastolic stunning • strain

Abbreviations and Acronyms   2D = 2-dimensional   PEAK = peak strain   LV = left ventricular   PCI = percutaneous coronary intervention   SI = strain imaging   SI-DI = strain imaging diastolic index   T = time to peak strain

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