title: Postsystolic shortening of ischemic myocardium: a mechanism of abnormal intraventricular filling.
abstract: Acute myocardial ischemia has been associated with abnormal filling patterns in the left ventricular (LV) apex. We hypothesized that this may in part be due to postsystolic shortening of ischemic apical segments, which leads to reversal of early diastolic apical flow. Fourteen open-chest anesthetized dogs were instrumented with micromanometers in the LV apex and left atrium and myocardial sonomicrometers in the anterior apical LV wall. Intraventricular filling by color Doppler and wall motion by strain Doppler echocardiography (SDE) were assessed from an apical view. Measurements were taken before and after 5 min of left anterior descending coronary artery (LAD) occlusion. In four dogs, we measured the pressure difference between the LV apex and outflow tract. At baseline, peak early diastolic flow velocities in the distal one-third of the LV were directed toward apex (9.2 +/- 1.6 cm/s). After LAD occlusion, the velocities reversed (-2.3 +/- 0.4 cm/s, P < 0.01), indicating that blood was ejected from the apex toward the base during early filling. This interpretation was confirmed by wall motion analysis, which showed postsystolic shortening of apical myocardial segments. The postsystolic shortening represented 9.7 +/- 1.7% (P < 0.01) and 14.2 +/- 2.4% (P < 0.01) of end-diastolic segment length by SDE and sonomicrometry, respectively. Consistent with the velocity changes, we found reversal of the early diastolic pressure gradient from the LV apex to outflow tract. In the present model, acute LAD occlusion resulted in reversal of early diastolic apical flow, and this was attributed to postsystolic shortening of dyskinetic apical segments. The clinical diagnostic importance of this finding remains to be determined.
authors.affiliation: Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo, N-0027 Norway.
authors.forename: Stig
authors.initials: S
authors.lastname: Urheim
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
authors.forename: Kjetil
authors.initials: K
authors.lastname: Steine
authors.forename: Helge
authors.initials: H
authors.lastname: Skulstad
authors.forename: Erik
authors.initials: E
authors.lastname: Lyseggen
authors.forename: Olaf
authors.initials: O
authors.lastname: Rodevand
authors.forename: Otto A
authors.initials: OA
authors.lastname: Smiseth
mesh_terms: D000818:Animals; D016279:Atrial Function, Left / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D004285:Dogs; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000503:physiopathology; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D017202:Myocardial Ischemia / Q000503:physiopathology*; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology