Digital subtraction high-frame-rate echocardiography in detecting delayed onset of regional left ventricular relaxation in ischemic heart disease.

BACKGROUND Because left ventricular (LV) diastolic function is impaired before systolic function in patients with ischemic heart disease and because ischemic heart disease is constituted of regional rather than global abnormalities of the left ventricle, measures of LV regional diastolic dysfunction, if possible, should provide the most sensitive assessment of the coronary involved region. The objectives of this study are to clarify whether high-frame-rate two-dimensional echocardiography, combined with digital subtraction image processing, may be used to visualize regional LV relaxation abnormalities in patients with ischemic heart disease and to clarify whether this technique provides a measure for the noninvasive assessment of the coronary involved region. METHOD AND RESULTS In 30 normal subjects and 59 patients with ischemic heart disease, two-dimensional echocardiograms obtained at a rate of 60 frames per second were provided on line for digital subtraction analysis, with which digitized images were continuously subtracted on a frame-by-frame basis. The subtracted images were analyzed to determine the onset of the segmental outward motion of the LV wall in early diastole in each of 16 segments per subject. Regional relaxation index, defined as the interval from the second heart sound to the onset of outward wall motion, was significantly prolonged in the coronary involved segments compared with the normal segments (36.3 +/- 18.0 versus 101.2 +/- 34.0 ms, P < .01). The prolongation in the regional relaxation index was observed even in the coronary involved segments without reduction in systolic wall motion. When a cutoff level of 50.0 ms was used, coronary involved segments could be distinguished from normal or border segments with a sensitivity of 92% and a specificity of 81%. CONCLUSIONS Digital subtraction high-frame-rate echocardiography may be used to visualize regional LV relaxation abnormalities in patients with ischemic heart disease. The time interval from the second heart sound to the onset of the segmental outward motion of the LV wall (regional relaxation index) obtained with this technique provides a noninvasive and accurate measure for assessing coronary involved regions.

[1]  V. Dilsizian,et al.  Impaired left ventricular filling and regional diastolic asynchrony at rest in coronary artery disease and relation to exercise-induced myocardial ischemia. , 1991, The American journal of cardiology.

[2]  T. Ryan,et al.  Improvement in rest and exercise-induced wall motion abnormalities after coronary angioplasty: an exercise echocardiographic study. , 1990, Journal of the American College of Cardiology.

[3]  W Grossman,et al.  Left Ventricular Diastolic Pressure‐Segment Length Relations and End‐Diastolic Distensibility in Dogs with Coronary Stenoses: An Angina Physiology Model , 1984, Circulation research.

[4]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[5]  D. Gibson,et al.  Echocardiographic assessment of abnormal left ventricular relaxation in man. , 1976, British heart journal.

[6]  H. Kemp,et al.  Asynchronous ventricular relaxation: an angiographic temporal analysis of asynchronous left ventricular relaxation in man. , 1979, The American journal of cardiology.

[7]  D. Waters,et al.  Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion. , 1977, The American journal of cardiology.

[8]  A. DeMaria,et al.  Doppler echocardiographic evaluation of diastolic dysfunction. , 1991, Circulation.

[9]  K. Bailey,et al.  Restrictive left ventricular diastolic filling identifies patients with heart failure after acute myocardial infarction. , 1992, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[10]  J. V. Nixon,et al.  Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris or acute myocardial infarction. , 1990, The American journal of cardiology.

[11]  E. Lakatta,et al.  A cellular mechanism for impaired posthypoxic relaxation in isolated cardiac myocytes. Altered myofilament relaxation kinetics at reoxygenation. , 1991, Circulation research.

[12]  Michael V. Green,et al.  Effects of aging on asynchronous left ventricular regional function and global ventricular filling in normal human subjects. , 1988, Journal of the American College of Cardiology.

[13]  R. Bonow.  Regional left ventricular nonuniformity. Effects on left ventricular diastolic function in ischemic heart disease, hypertrophic cardiomyopathy, and the normal heart. , 1990, Circulation.

[14]  S. Krueger,et al.  Correlation between segmental early relaxation of the left ventricular wall and coronary occlusive disease. , 1975, American heart journal.

[15]  P D Clayton,et al.  Should a fixed external reference system be used to analyze left ventricular wall motion? , 1982, Circulation.

[16]  D. Brutsaert,et al.  Nonuniformity: a physiologic modulator of contraction and relaxation of the normal heart. , 1987, Journal of the American College of Cardiology.

[17]  D. Gibson,et al.  Asynchronous left ventricular wall motion early after coronary thrombosis. , 1986, British heart journal.

[18]  W. Grossman.  Diastolic function and heart failure: an overview. , 1990, European heart journal.

[19]  M. Matsuzaki,et al.  Asynchronous left ventricular diastolic filling in patients with isolated disease of the left anterior descending coronary artery: assessment with radionuclide ventriculography. , 1984, Circulation.

[20]  W. Gaasch,et al.  Myocardial relaxation. VI. Effects of beta-adrenergic tone and asynchrony on LV relaxation rate. , 1983, The American journal of physiology.

[21]  S. Larson,et al.  Scintigraphic quantification of asynchronous myocardial motion during the left ventricular isovolumic relaxation period: a study in the dog during acute ischemia. , 1984, Journal of the American College of Cardiology.

[22]  P. Ludbrook,et al.  Association of Asynchronous Protodiastolic Segmental Wall Motion with Impaired Left Ventricular Relaxation , 1981, Circulation.

[23]  G. Freeman,et al.  Comparison of effects of dobutamine and ouabain on left ventricular contraction and relaxation in closed-chest dogs. , 1987, The Journal of clinical investigation.

[24]  K. Gould,et al.  Comparison of early systolic and early diastolic regional function during regional ischemia in a chronically instrumented canine model. , 1983, Journal of the American College of Cardiology.

[25]  D. Gibson,et al.  Regional left ventricular wall motion in pacing induced angina. , 1988, British heart journal.

[26]  P. Ludbrook,et al.  Factors Related to End‐Systolic Volume Are Important Determinants of Peak Early Diastolic Transmitral Flow Velocity , 1992, Circulation.

[27]  D. Gibson,et al.  Changes in left ventricular regional asynchrony after intracoronary thrombolysis in patients with impending myocardial infarction. , 1986, British heart journal.

[28]  Michael V. Green,et al.  Asynchronous left ventricular regional function and impaired global diastolic filling in patients with coronary artery disease: reversal after coronary angioplasty. , 1985, Circulation.

[29]  Michael V. Green,et al.  Impaired Left Ventricular Diastolic Filling in Patients with Coronary Artery Disease: Assessment with Radionuclide Angiography , 1981, Circulation.

[30]  T. Kumada,et al.  Left Ventricular Regional Relaxation and Its Nonuniformity in Hypertrophic Nonobstructive Cardiomyopathy , 1991, Circulation.

[31]  W. Lew,et al.  Influence of nonuniformity on rate of left ventricular pressure fall in the dog. , 1989, The American journal of physiology.

[32]  E. Topol,et al.  Immediate enhancement of left ventricular relaxation by coronary artery bypass grafting: intraoperative assessment. , 1988, Circulation.

[33]  R. Bonow,et al.  Regional left ventricular asynchrony and impaired global left ventricular filling in hypertrophic cardiomyopathy: effect of verapamil. , 1987, Journal of the American College of Cardiology.

[34]  J. Tanouchi,et al.  Pulmonary venous flow velocity pattern as assessed with transthoracic pulsed Doppler echocardiography in subjects without cardiac disease. , 1991, The American journal of cardiology.

[35]  K. Hammermeister,et al.  Regional variation in the timing and extent of left ventricular wall motion in normal subjects. , 1986, British heart journal.

[36]  Y. Hirota,et al.  A Clinical Study of Left Ventricular Relaxation , 1980, Circulation.

[37]  M. Hori,et al.  Effects of heart rate on left ventricular filling dynamics: assessment from simultaneous recordings of pulsed Doppler transmitral flow velocity pattern and haemodynamic variables. , 1993, Cardiovascular research.

[38]  P. Grayburn,et al.  Are Contraction and Relaxation Coupled in Patients With and Without Congestive Heart Failure? , 1992, Circulation.

[39]  S. Nakatani,et al.  Effects of changes in coronary stenosis on left ventricular diastolic filling assessed with pulsed Doppler echocardiography. , 1988, Journal of the American College of Cardiology.