Presence of Postsystolic Shortening Increases the Likelihood of Coronary Artery Disease: A Rest Electrocardiography-Gated Myocardial Perfusion SPECT Study

The Association Between Postsystolic Index and SYNTAX Score in Hospitalized Patients With Non-ST-Elevation Acute Coronary Syndrome

Objective:

Non-ST-elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous disorder including subgroups with a low or high risk for myocardial ischemia. The presence of postsystolic index (PSI) is associated with myocardial ischemia. The focus of this study was to find probable association between PSI and severity of coronary artery disease (CAD) in a cohort of patients.

Materials and Methods:

This was a cross-sectional study that consisted of 83 patients with unstable angina, non-ST-segment myocardial infarction (UA/NSTEMI), and a left ventricular ejection fraction ≥50%, without visible regional wall motion abnormalities. All patients underwent echocardiography, and global longitudinal strain (GLS), PSI, and mitral annular peak systolic (s′) and early diastolic (e′) velocities were measured. Coronary angiography was then performed, and a SYNTAX score was calculated.

Results:

The patient cohort was divided into two groups based on their high and low SYNTAX scores. PSI and GLS were higher in those patients with a higher SYNTAX score than in individuals with a lower score (85.04% ± 67.02% vs 46.67 ± 39.03, P = .001 and −16.09 ± 3.70 vs −17.99 ± 2.87, P = .012, respectively). Among the different variables assessed, only PSI was an independent predictor of a high SYNTAX score ( B = 1.014, 95% confidence interval [CI]: 1.001–1.027, P = .034).

Conclusion:

This cohort study demonstrated that a cumulative PSI may be predictive of much more complex and extensive CAD, especially in patients with UA/NSTEMI.

Myocardial Postsystolic Shortening and Early Systolic Lengthening: Current Status and Future Directions

The concept of paradoxical myocardial deformation, commonly referred to as postsystolic shortening and early systolic lengthening, was originally described in the 1970s when assessed by invasive cardiac methods, such as ventriculograms, in patients with ischemia and animal experimental models. Today, novel tissue-based imaging technology has revealed that these phenomena occur far more frequently than first described. This article defines these deformational patterns, summarizes current knowledge about their existence and highlights the clinical potential associated with their understanding.

Left Ventricular Strain and Dyssynchrony in Young and Middle-Aged Peritoneal Dialysis Patients and Healthy Controls: A Case-Matched Study

BACKGROUND

This study aimed to evaluate the role of two-dimensional speckle-tracking imaging (2D-STI) and myocardial layer-specific analysis in evaluating early left ventricular (LV) myocardial function and systolic dyssynchrony in young and middle-aged uremic patients undergoing peritoneal dialysis (PD).

METHODS

We enrolled 31 PD patients aged ≤65 years with preserved LV ejection fraction (LVEF, ≥54%) as the PD group and 49 age-matched healthy people as the control group. Echocardiography was used to assess the left atrial diameter index (LADI, LAD/BSA), LV mass index (LVMI), LVEF, peak early diastolic velocity/late diastolic velocity (E/A) (measured by pulsed Doppler), and peak early diastolic velocity (by pulsed Doppler)/peak velocity of the early diastolic wave (by pulsed-wave tissue Doppler) (E/e'). Next, we used 2D-STI and myocardial layer-specific analysis to obtain longitudinal strains (LS) of the endocardium (LSendo), the myocardium (LSmyo), the epicardium (LSepi), and the global myocardium (GLS). Then, we measured the postsystolic index (PSI) to evaluate LV myocardial function. Time to peak LS (TTP) and peak strain dispersion (PSD) from 17 consecutive segments were assessed to quantify LV dyssynchrony.

RESULTS

Compared with the controls, PD patients had significantly increased LADI (p = 0.041), LVMI (p = 0.000), and E/e' (p = 0.009), but reduced LVEF (p = 0.000) and E/A (p = 0.000). The average values of GLS (GLS avg) (p = 0.01) and GLS of the apical 2-chamber view (p = 0.003), including the LSendo (p = 0.024), LSmyo (p = 0.024), and LSepi (p = 0.032), were significantly decreased in patients with PD compared with controls. In PSI, segments of LS were markedly delayed in the anterior septum (p = 0.047), anterior (p = 0.000) and septum wall (p = 0.024) from basal segments, anterior wall (p = 0.001) from middle segments, and anterior (p = 0.024) and inferior (p = 0.024) wall from apical segments. Moreover, PSD was significantly increased in PD patients (p = 0.015), while TTP was evidently delayed in the anterior septum (p = 0.004), anterior (p = 0.000) and posterior (p = 0.042) wall from basal segments, and inferior wall (p = 0.048) from apical segments.

CONCLUSIONS

Despite preserved LVEF, young and middle-aged PD patients developed LV dysfunction and myocardial systolic dyssynchrony earlier compared with controls.