Abstract 15423: Usefulness of Three-Dimensional Speckle Tracing Strain to Detect the Site of Prolonged Post-Ischemic Left Ventricular Diastolic Stunning Following Coronary Vasospasm
Background: Three-dimensional speckle tracking imaging (3D-SI) has been recently developed to quantify left ventricular (LV) stain using complete pyramidal datasets. We investigated whether impaired regional LV relaxation could actually be diagnosed using 3D-SI and how long the regional diastolic dysfunction persists after coronary vasospasm (CV).
Method: Thirty-eight consecutive patients (26 men, 60 ± 9 years) with variant angina, diagnosed by intracoronary acetylcholine injection, were studied. The 3D-SI was obtained by using an ultrasound system (ARTIDA, Toshiba Medical Systems) with PST-25SX probe. The 3D-SI software automatically divided the LV into 16 segments and generated corresponding time-strain curves from each segment. The end systolic values of radial strain at the closure of aortic valve (A) and at the one-third point of diastole duration (B) were measured. 3D-SI diastolic index (3D-SIDI) was defined as (A-B)/A ×100% to assess the regional LV active relaxation. Three major coronary perfusion territories were assigned as :1) the mid-anteroseptal segment to the left anterior descending coronary artery; 2) the mid- lateral segment to the left circumflex branch; and 3) the mid-inferior segment to the right coronary artery. The mean 3D-SIDI in 30 control subjects was 84 ± 6%, 86 ± 8%, 83 ± 7% in the anteroseptal, lateral, and inferior segments, respectively. The first 3D-SI study was performed within 1 week before coronary angiography (CAG), and the second study was performed approximately 24 hours after. The 3D-SI study was then repeated 1, 2, and 4 weeks after.<bold>
Results: The mean 3D-SIDI was -14.3 ± 15.8% in the 45 territories perfused by the coronary arteries with spasm, similar to that noted before CAG (-10.6 ± 12.9%). In patients with no angina, the 3D-SIDI of the 28 territories perfused by the coronary arteries with spasm significantly increased 21.7 ± 11.5%, 48 ± 18.6%, and 80 ± 8.7% (p < 0.05) during 3D-SI study. The index had no improvement in the 7 patients who experienced recurrent angina despite treatment.
Conclusion: Echocardiographic evaluation of regional myocardial wall motion by 3D-SI is a useful method for detecting prolonged post-ischemic diastolic stunning and for identifying the angina-provoking vessel in patients with CV.
- © 2011 by American Heart Association, Inc.