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(Circulation. 1995;91:552-554.)
© 1995 American Heart Association, Inc.

Articles

`High Time' for Noninvasive Assessment of Regional Ventricular Diastolic Ischemic Dysfunction

Richard L. Popp, MD

From the Cardiovascular Medicine Division, Department of Medicine, Stanford University School of Medicine, Stanford, Calif.

Key Words: Editorials • ischemia • echocardiography • diastole

	Introduction

 
Two-dimensional (2D) tomographic images of the heart first were obtained by ultrasound about 20 years ago. The equipment has been improved gradually, Doppler analysis has been added, and the technique has been accepted widely within the last 10 years. Echocardiographic imaging is used to assess ischemic heart disease by displaying the segmental wall motion abnormalities of acute myocardial infarction, chronic wall motion abnormalities from chronic ischemia or prior infarction, and stress-induced wall motion abnormalities, as well as complications of this condition such as ventricular thrombi, postinfarction ventricular septal defect, ventricular remodeling, and aneurysm formation. The initial diagnosis of coronary artery disease (CAD) now is confirmed commonly by stress echocardiography. Deterioration or lack of the expected improvement in systolic wall motion after exercise or during pharmacological stress, compared with the resting images, labels the patient as having coronary stenosis.¹ Stress echocardiography usually is not analyzed quantitatively. Very experienced expert interpreters are quite accurate in recognizing CAD with this "quantitative" technique with sensitivities exceeding 80% and specificities approximately 90%. Those less expert in the technique do not achieve such good results.² Various approaches to quantitative analysis of echocardiographic images have been attempted to standardize the interpretation of the images, using computer measurement of wall motion.^{3 4} The goal is to provide the equivalent of expert interpretation to those who are less experienced, usually for recognition of patients with ischemic heart disease.

	The Problem of Characterizing Diastolic Function

 
Abnormalities of ventricular filling and of myocardial relaxation are sensitive early signs of myocardial ischemia in acute experiments in animals and humans. . . . [Full Text of this Article]

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