Published Online
on May 31, 2005

A more recent version of this article appeared on June 7, 2005

This Article Full Text (PDF) All Versions of this Article: 111/22/2943    most recent CIRCULATIONAHA.104.482984v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, J. Articles by Belohlavek, M. Search for Related Content PubMed PubMed Citation Articles by Wang, J. Articles by Belohlavek, M. Related Collections Contractile function Animal models of human disease Echocardiography Acute myocardial infarction Chronic ischemic heart disease

Submitted on June 8, 2004
Revised on January 25, 2005
Accepted on February 23, 2005

Delayed Onset of Subendocardial Diastolic Thinning at Rest Identifies Hypoperfused Myocardium

Jianwen Wang MD, PhD, Theodore P. Abraham MD, Josef Korinek MD, Stig Urheim MD, Eileen M. McMahon PhD, and Marek Belohlavek MD, PhD^*

From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn.

^* To whom correspondence should be addressed. E-mail: belohlavek.marek{at}mayo.edu.

Background--Onset of myocardial relaxation is highly energy dependent. Perfusion and therefore energy substrate delivery are predominantly reduced in the subendocardial myocardium in the early stages of progressive ischemia. We hypothesized that delayed onset of subendocardial diastolic thinning will functionally identify regionally hypoperfused resting myocardium.

Methods and Results--Progressive left anterior descending coronary artery stenosis was induced by an ameroid occluder and maintained for 1 or 2 weeks (end point) in 12 dogs. M-mode tissue Doppler images of the anterior apical and middle segments (testing region) and middle inferior segment (control region) were acquired selectively in the subendocardium and subepicardium. The time to the onset of thinning was measured with the use of tissue Doppler velocity (TOTv) and a thickness function (TOTt). At the end point in the testing region, myocardial flow was significantly lower in the subendocardial layer (P<0.05) in all animals, whereas viability staining showed preserved transmural viability in 10 dogs and thin subendocardial necrosis in 2 dogs. Both TOTv and TOTt were significantly (P<0.01) prolonged in the testing region. The mean difference between subendocardial and subepicardial TOTv values versus that in the control region identified the ischemic region, even when only dogs with hypoperfused but transmurally viable myocardium were considered (P<0.05). Systolic and diastolic myocardial velocities did not identify subendocardial hypoperfusion.

Conclusions--In resting myocardium subtended to progressive coronary stenosis, a delayed onset of subendocardial thinning suggests an early stage of hypoperfusion, before the development of local wall motion abnormalities.

Key words: myocardial relaxation • ischemia • regional blood flow • echocardiography • diastole

This article has been cited by other articles:

				K. Ishii, T. Suyama, M. Imai, M. Maenaka, A. Yamanaka, Y. Makino, Y. Seino, K. Shimada, and J. Yoshikawa 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. J. Am. Coll. Cardiol., October 20, 2009; 54(17): 1589 - 1597. [Abstract] [Full Text] [PDF]

				K. Ishii, M. Imai, T. Suyama, M. Maenaka, T. Nagai, M. Kawanami, and Y. Seino Exercise-Induced Post-Ischemic Left Ventricular Delayed Relaxation or Diastolic Stunning Is it a Reliable Marker in Detecting Coronary Artery Disease? J. Am. Coll. Cardiol., February 24, 2009; 53(8): 698 - 705. [Abstract] [Full Text] [PDF]

				G.-P. Diller, B. S. Wasan, A. Kyriacou, N. Patel, R. P. Casula, T. Athanasiou, D. P. Francis, and J. Mayet Effect of coronary artery bypass surgery on myocardial function as assessed by tissue Doppler echocardiography Eur. J. Cardiothorac. Surg., November 1, 2008; 34(5): 995 - 999. [Abstract] [Full Text] [PDF]

				K. Matre, C. A. Moen, T. Fannelop, G. O. Dahle, and K. Grong Multilayer radial systolic strain can identify subendocardial ischemia: An experimental tissue Doppler imaging study of the porcine left ventricular wall Eur J Echocardiogr, December 1, 2007; 8(6): 420 - 430. [Abstract] [Full Text] [PDF]

				D. S. Owens and J. F. Plehn Recognizing Unrecognized Risk: The Evolving Role of Ventricular Functional Assessment in Population-Based Studies Circulation, July 10, 2007; 116(2): 126 - 130. [Full Text] [PDF]

				T.-H. Park, S. F. Nagueh, D. S. Khoury, H. A. Kopelen, S. Akrivakis, K. Nasser, G. Ren, and N. G. Frangogiannis Impact of myocardial structure and function postinfarction on diastolic strain measurements: implications for assessment of myocardial viability Am J Physiol Heart Circ Physiol, February 1, 2006; 290(2): H724 - H731. [Abstract] [Full Text] [PDF]