Detection of incoordinate isovolumic relaxation in infarcted patients: Assessment by quantitative two-dimensional echocardiography

Analysis of left ventricular function in ischemic patients has been focused recently on the abnormalities of the diastolic phases of relaxation and filling. To assess if the quantitative analysis of the two-dimensional (2-D) echocardiographic images can detect the abnormalities of the isovolumic relaxation period (IRP), and their relation to regional systolic function, 27 infarcted patients and 15 normals, with high-quality echocardiographic examinations, were studied. The area of the endocardial silhouette significantly increased during IRP, both in normals and in infarcted patients (p < .001 for both); the percentage increase was 11.3 ± 7.1% in normals and 11.9 ± 7.8% in patients. This increase in the ventricular area is probably expression of a shape change of the ventricle, which becomes more spherical during IRP. Endocardial regional wall motion was assessed frame-by-frame according to a fixed reference system and quantified as the area shrinkage (AS%) of 12 sectors. Abnormal regional movements during IRP were detected in 20 patients and, in particular, outward movement in 11, inward movement in 5, and both outward and inward movement in 4. Outward movements affected segments with normal systolic function in 82.4% of the cases; inward movements affected segments with depressed systolic function in 72.9%: the distribution is highly statistically significant (p < .001). The quantitative analysis of 2-D echocardiography was able to detect IRP abnormalities in 74.1% of the patients, and although appliable at present only in selected examinations, it appears to be the only noninvasive technique that can assess quantitatively regional abnormalities of the isovolumic relaxation period.