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Assessment of Myocardial Ischemic Memory Using Persistence of Post-Systolic Thickening After Recovery From Ischemia

Department of Functional Diagnostic Science, Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

^_* Reprint requests and correspondence: Dr. Toshihiko Asanuma, Department of Functional Diagnostic Science, Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan (Email: toshi{at}sahs.med.osaka-u.ac.jp).

Objectives: We sought to investigate the time course of post-systolic thickening (PST) and systolic abnormality after recovery from brief myocardial ischemia.

Background: Myocardial ischemic memory imaging, denoting the visualization of abnormalities provoked by ischemia and sustained even after restoration of perfusion, is desirable and allows after-the-fact recognition of ischemic insult. PST offers a sensitive marker of myocardial ischemia, but whether this abnormal thickening remains after relief from brief ischemia is unclear.

Methods: Tissue strain echocardiographic data were acquired from 27 dogs under 2 different conditions of myocardial ischemia induced by either brief coronary occlusion (15 or 5 min) followed by reperfusion (Protocol 1) or by dobutamine stress during nonflow-limiting stenosis (Protocol 2). Peak systolic strain and post-systolic strain index (PSI), a parameter of PST, were analyzed.

Results: In Protocol 1, peak systolic strain was significantly decreased in the risk area during occlusion. This decrease in peak systolic strain in the 15-min group did not completely recover to baseline levels even 120 min after reperfusion, whereas the decrease in the 5-min group recovered immediately after reperfusion. We found that PSI was significantly increased during occlusion, but increased PSI in the 5-min group remained until 30 min after reperfusion (–0.19 ± 0.18 [baseline] vs. 0.19 ± 0.14 [30 min], p < 0.05) despite the rapid recovery of peak systolic strain. In Protocol 2, increased PSI was sustained until 20 min after the end of dobutamine infusion (–0.26 ± 0.11 [baseline] vs. –0.16 ± 0.10 [20 min], p < 0.05), although peak systolic strain recovered by 5 min after the end of dobutamine infusion.

Conclusions: PST remained longer than abnormal peak systolic strain after recovery from ischemia. Assessment of PST may be valuable for detecting myocardial ischemic memory.

Key Words: echocardiography • ischemic heart disease • myocardial strain

Abbreviations and Acronyms   AVC = aortic valve closure   LAD = left anterior descending artery   LCX = left circumflex artery   MCE = myocardial contrast echocardiography   PSI = post-systolic strain index   PST = post-systolic thickening   ROI = region of interest   TSE = tissue strain echocardiography

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