Liver Cirrhosis and/or Hepatocellular Carcinoma Occurring Late After the Fontan Procedure　- A Nationwide Survey in Japan.

BACKGROUND: Fontan-associated liver disease (FALD) is an important late complication involving liver dysfunction, such as liver cirrhosis (LC) and hepatocellular carcinoma (HCC), in patients undergoing the Fontan procedure. However, the prevalence, clinical manifestation, and methods of diagnosis of FALD are still not well established.Methods and Results:This study comprised 2 nationwide surveys in Japan. First, the prevalence of LC and/or HCC in patients undergoing the Fontan procedure was determined. Second, clinical manifestations in patients with LC and/or HCC were analyzed, along with data from blood tests, echocardiography, and right heart catheterization. In the 1st survey, of the 2,700 patients who underwent the Fontan procedure, 31 were diagnosed with LC and/or HCC (1.15%), and 5 died due to liver diseases (mortality: 0.19%). In the 2nd survey, data were collected from 17 patients (12 with LC, 2 with HCC, and 3 with LC+HCC. Of these 17 patients, 5 died (mortality: 29.4%). The mean age at diagnosis of LC and HCC was 23 and 31 years, respectively. Computed tomography followed by ultrasound was most frequently used for diagnosis. Blood tests revealed low platelet counts, increased hemoglobin, aspartate aminotransferase, γ-guanosine triphosphate, and total bilirubin levels, and an elevated international normalized ratio of prothrombin time. CONCLUSIONS: LC and/or HCC in patients undergoing the Fontan procedure were not rare late complications and were associated with high mortality rates.

Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease.

BACKGROUND: Cardiovascular risk stratification of asymptomatic diabetic patients is important and remains a difficult clinical problem. Our aim was to test the hypothesis that coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography predicts prognosis in those patients. METHODS: From February 2002 to January 2005, we evaluated 135 consecutive asymptomatic patients (74 male; mean age, 63 ± 9 years) with type 2 diabetes without a history of coronary artery disease. Adenosine triphosphate (0.14 mg/kg/min) stress Doppler echocardiography was performed to evaluate CFR of the left anterior descending artery. Patients with a CFR < 2.0 were also excluded based on the suspicion of significant coronary artery stenosis in the left anterior descending artery. RESULTS: There were 111 patients (60 male; mean age, 64 ± 9 years) enrolled. During a median follow-up of 79 months, 20 events (5 deaths, 7 acute coronary syndromes, 8 coronary revascularizations) occurred. The optimal cut-off value of CFR to predict events was 2.5 (area under the receiver-operating characteristic curve = 0.65). Multivariate analysis showed that the independent prognostic indicators were male gender (p < 0.05) and a CFR < 2.5 (p < 0.01). Kaplan-Mayer analysis revealed that the event rate was significantly higher (log-lank, p < 0.01) in patients with CFR < 2.5 than in those with CFR ≥ 2.5. CONCLUSIONS: CFR obtained by transthoracic Doppler echocardiography provides independent prognostic information in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Patients with CFR < 2.5 had a worse long-term outcome.

Opinions of physicians regarding problems and tasks involved in the medical care system for patients with adult congenital heart disease in Japan.

BACKGROUND: The aim of this study is to summarize the opinions of physicians regarding problems and tasks involved in the medical care system for patients with adult congenital heart disease (ACHD) in Japan. METHODS AND RESULTS: We conducted a semistructured interview with 30 subjects consisting of 13 pediatric cardiologists, 11 cardiovascular surgeons, and six cardiologists who were selected from among the randomly sampled medical facilities meeting each of the following institutional criteria: (1) facilities with ≥50 ACHD outpatients; (2) facilities with ACHD-specialized outpatient clinic; (3) facilities that are members of the Japanese Association of Chirdren's Hospitals and Related Facilities. The interview time was 27-91 minutes (mean, 70.0). The age of the subjects ranged from 36 to 62 years (mean, 46.7), and they had 0.5-34 years (mean, 16.2) of experience in treating congenital heart disease. From an analysis of interview details, the following four themes were extracted (in descending order of the number of comments): "(1) Who should treat ACHD" (comments by 29 subjects), "(2) Centralization of medical care" (comments by 29 subjects), "(3) What is the role of children's hospitals in ACHD?" (comments by 24 subjects), and "(4) Psychosocial problems" (comments by 24 subjects). CONCLUSIONS: Regional ACHD centers need to be established to promote centralization of patients, physicians, and educational function. This will provide higher quality medical service to more patients in the near future.

Prevalence of adult patients with congenital heart disease in Japan.

BACKGROUND: Today most patients with congenital heart disease (CHD) can be expected to survive into adulthood. Reports regarding the number of adults with CHD in Japan are scarce. Our study aims to define the number of these adults. MATERIAL AND METHODS: The estimated number of infants born in Japan with major CHDs since 1947 was calculated together with mortality rates. We estimated the number of CHD survivors from data on survival rates of unoperated and postoperative patients. The number of deaths from 1968 to 1997 was analyzed using individual death certificates held by the Japanese Government. RESULTS: In 1967, 163,058 patients with CHD including 53,846 adults were assumed to be alive. From 1968 to 1997, 548,360 patients with CHD were born and 82,919 died. A total of 622,800 patients, including 304,474 children (49%) and 318,326 adults (51%) were estimated to be alive in 1997. From 1997 to 2007, there has been an estimated increase of 9000 adults every year, and in 2007, 409,101 adults are estimated to be alive. CONCLUSIONS: The prevalence in adults with CHD in Japan has explosively increased from 1967 to 2007. There were 409,101 adults with CHD in 2007 with an annual increase of 9000. These data are crucial for planning the establishment in Japan of special facilities and resources necessary for the care of these patients.

The prevalence and risk factors for cholelithiasis and asymptomatic gallstones in adults with congenital heart disease.

PURPOSE: Cyanosis is considered to be a risk factor for cholelithiasis which is an important complication of cyanotic congenital heart disease (CCHD) in adults. In this study, the prevalence of cholelithiasis and asymptomatic calcium bilirubinate gallstones was evaluated in adults with congenital heart disease (CHD). Furthermore, risk factors for this potentially high risk complication were assessed. MATERIALS AND METHODS: Subjects were derived from 114 consecutive congenital patients who visited our center from May 2008 to January 2009. For analyses of risk factors, we divided them into 4 groups: group A, 15 CCHD patients without reparative surgery (7 men, 31.8 ± 7.0 years old); group B, 41 CCHD patients rendered acyanotic by reparative surgery (21 men, 32.5 ± 11.8 years old); group C, 23 unoperated acyanotic CHD patients (11 men, 42.4 ± 16.4 years old); and group D, 35 patients who were acyanotic before and after operation (18 men, 36.3 ± 14.8 years old). Gallstones were identified by abdominal ultrasound and risk factors were analyzed by a multivariate logistic regression model. RESULTS: Cholecystectomy was performed in 5/114 (4.3%), asymptomatic gallstones were seen in 16/114 (14%), and symptomatic gallstones except for patients after cholecystectomy were seen in 7/114 (6.1%). In group A, 4 (27%) with gallstones underwent cholecystectomy (p<0.01). Non-cholesterol gallstones were observed in 5 patients (33%) in group A, 12 patients (29%) in group B, nobody in group C, and 3 patients (8.6%) in group D. By a multivariate logistic regression model, CCHD by nature regardless of repair, prolonged cyanosis periods, higher frequency of cardiopulmonary bypass (CPB), and lower platelet counts were significant factors predicting gallstones (odds ratio 4.48, 1.08, 3.96, and 0.87, 95% CI, 1.14-17.5, 1.00-1.18, 1.65-9.54, and 0.75-0.99, respectively). CONCLUSIONS: The prevalence of cholelithiasis and asymptomatic gallstones is significantly high in CCHD patients regardless of cardiac repairs. CCHD by nature, prolonged cyanosis durations, high frequency of CPB and low platelet counts have influences on gallstone formation in adults with CHD.

The impact of sleep deprivation on the coronary circulation.

Epidemiologic studies have reported that sleep deprivation is associated with cardiovascular events. However, it remains unknown how sleep deprivation affects the coronary circulation. We assessed the impact of sleep deprivation on the coronary circulation using coronary flow velocity reserve (CFVR) measurements with transthoracic Doppler echocardiography. We studied 26 healthy male volunteers. Each subject's CFVR was measured in the morning after sleep deprivation (less than 4 h) or normal sleep (more than 7 h) on different days. Sleep durations were 3.7 ± 0.9 h (sleep deprivation) and 7.1 ± 0.2 h (normal sleep). CFVR after sleep deprivation was significantly lower than that after normal sleep (3.3 ± 0.6 versus 4.2 ± 0.9, p<0.001). Short sleep duration attenuated CFVR compared with normal sleep duration. This finding suggests that sleep deprivation might serve as a trigger for cardiovascular events.

Nationwide survey of care facilities for adults with congenital heart disease in Japan.

BACKGROUND: The number of adults with congenital heart disease (CHD) is increasing rapidly, but care programs have not been fully established in Japan. METHODS AND RESULTS: Questionnaires regarding current status and resources of outpatient and in-hospital services, and management of pregnancy in patients with adult CHD (ACHD) were sent to 1,033 training hospitals for board-certified cardiologists. Useful replies were obtained from 458 hospitals (44%). In 417 hospitals (91%), at least 1 patient was followed in the outpatient clinic; however, only 14 hospitals (3%) had specialized outpatient clinics; 354 hospitals (77%) had in-hospital patients, but only 6 hospitals (2%) admitted >50 patients per year. Surgery for ACHD was performed in 232 hospitals (51%), but in 135 of these (58%), the number of operations was <5 per year. Pregnant women with CHD were managed in 157 hospitals (34%), although only 3 hospitals (2%) managed >10 cases per year. CONCLUSIONS: In most hospitals in Japan, a limited number of ACHD patients have been followed up and specialized multi-disciplinary facilities for ACHD need to be established.

Effect of angiotensin-converting enzyme inhibitor on serum asymmetric dimethylarginine and coronary circulation in patients with type 2 diabetes mellitus.

Measurements of serum asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and coronary flow velocity reserve (CFVR) using transthoracic Doppler echocardiography were performed at baseline and after 4 weeks of temocapril therapy (2 mg/day) in 18 patients with type 2 diabetes. Although blood pressure, fasting blood sugar and lipid profiles remained unchanged, serum ADMA concentrations decreased significantly (0.51+/-0.08 to 0.46+/-0.07 micromol/l, p<0.01) and CFVR increased significantly (2.78+/-0.36 to 3.35+/-0.46, p<0.001) after the treatment. Moreover, a strong correlation was observed between the difference of ADMA and that of CFVR (r=-0.80, p<0.001). Temocapril reduced serum ADMA concentrations, improved CFVR beyond its blood pressure lowering effect. Our results suggest that decrease in ADMA by temocapril treatment is related to improvement of coronary circulation as determined by CFVR in patients with type 2 diabetes.

Prediction of the response to beta-blocker therapy in patients with dilated cardiomyopathy: comparison of 123I-MIBG scintigraphy and low-dose dobutamine stress echocardiography.

BACKGROUND: In this study, we aimed to compare low-dose dobutamine stress echocardiography (DSE) and iodine 123-metaiodobenzylguanidine (MIBG) scintigraphy for predicting the response to beta-blocker therapy in patients with dilated cardiomyopathy (DCM). METHODS: MIBG imaging was performed in 10 patients with DCM (mean EF 28 ± 8%), who were subsequently treated with beta-blocker therapy. The heart-to-mediastinum (H/M) MIBG uptake ratio was evaluated in initial and delayed images, and the percent washout ratio of myocardial MIBG was determined. DSE was also performed in all patients to measure left ventricular ejection fraction (LVEF) at rest and during dobutamine infusion (10 µg/kg/min). LVEF at rest was also assessed by echocardiography before and after 6 months of beta-blocker therapy. RESULTS: LVEF was significantly improved after beta-blocker therapy (28 ± 8 to 41 ± 11%, p < 0.001). The relative change in LVEF after beta-blocker therapy was significantly correlated with the relative change in LVEF during DSE (r = 0.68, p < 0.03). The H/M MIBG uptake ratio in both early and delayed imaging was not significantly correlated with the relative change in LVEF in response to beta-blockade therapy. CONCLUSIONS: The relative change in LVEF during DSE, but not MIBG imaging predicted the relative change in LVEF in response to beta-blockade therapy in a limited number of DCM patients.

Relaxation effects of lavender aromatherapy improve coronary flow velocity reserve in healthy men evaluated by transthoracic Doppler echocardiography.

PURPOSE: It has been reported that mental stress is an independent risk factor for cardiovascular events and impairs coronary circulation. Lavender aromatherapy, one of the most popular complementary treatments, is recognized as a beneficial mental relaxation therapy. However, no study has examined the effect of this therapy on coronary circulation. We aimed to assess the effect of lavender aromatherapy on coronary circulation by measuring coronary flow velocity reserve (CFVR) with noninvasive transthoracic Doppler echocardiography (TTDE). MATERIAL AND METHODS: We enrolled 30 young healthy men (mean age 34+/-4.7 years, range 24-40 years). Coronary flow velocities in the left anterior descending coronary artery were recorded by TTDE at rest and during hyperemia induced with an intravenous infusion of adenosine triphosphate (ATP). CFVR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. CFVR was assessed at baseline and immediately after lavender aromatherapy (four drops of essential oil diluted with 20 ml of hot water and inhaled for 30 min). Simultaneously, serum cortisol was measured as a marker of stress hormones. To exclude the relaxation effects of rest, the same measurements were repeated in the same volunteers without aromatherapy as a control study. RESULTS: CFVR measurements were obtained in all volunteers (100%). Blood pressure and heart rate responses to ATP infusion were not affected by lavender aromatherapy. Serum cortisol significantly decreased after lavender aromatherapy (8.4+/-3.6 to 6.3+/-3.3, p<0.05), but remained unchanged in controls (9.1+/-3.5 to 8.1+/-3.9, p=ns). In addition, CFVR significantly increased after lavender aromatherapy (3.8+/-0.87 to 4.7+/-0.90, p<0.001), but not in controls (3.9+/-0.8 to 3.9+/-0.8, p=ns). CONCLUSIONS: Lavender aromatherapy reduced serum cortisol and improved CFVR in healthy men. These findings suggest that lavender aromatherapy has relaxation effects and may have beneficial acute effects on coronary circulation.

Effect on coronary flow velocity reserve in patients with type 2 diabetes mellitus: comparison between angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor antagonist.

BACKGROUND: The effects of angiotensin antagonists on coronary circulation in type 2 diabetes are unclear. We aimed to assess whether 4 weeks of treatment with angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist improves coronary flow velocity reserve (CFVR) in patients with type 2 diabetes. METHODS: Twenty-four asymptomatic patients with type 2 diabetes were randomly assigned to temocapril (2 mg/d) or candesartan (8 mg/d). Coronary flow velocity reserve, calculated as the ratio of adenosine-induced hyperemic to basal coronary flow velocity, was measured with transthoracic Doppler echocardiography. Coronary flow velocity reserve measurement and venous blood sampling were performed before and after 4 weeks of treatment. We also obtained CFVR and venous blood data in the 8 healthy controls. RESULTS: Coronary flow velocity reserve was significantly lower in patients than controls (temocapril group 2.74 +/- 0.28, candesartan group 2.65 +/- 0.30, controls 3.53 +/- 0.23, P < .0001 for both, respectively). Blood pressure was reduced in both diabetic groups (n = 12 each) similarly 4 weeks after treatment. There were no significant differences between the 2 groups in venous blood data before or after treatment. However, CFVR increased significantly in the temocapril group (2.74 +/- 0.28 to 3.31 +/- 0.36, P < .0001), but not in the candesartan group (2.65 +/- 0.30 to 2.71 +/- 0.43, P = ns). CONCLUSIONS: Coronary flow velocity reserve in patients with type 2 diabetes improved after treatment with temocapril but not with candesartan, suggesting that angiotensin-converting enzyme inhibitor, but not angiotensin II type 1 receptor antagonist, might have beneficial effects on coronary microangiopathy associated with type 2 diabetes.

Cardioprotective effects of granulocyte colony-stimulating factor in swine with chronic myocardial ischemia.

OBJECTIVES: The aim of this study was to investigate the effect of granulocyte colony-stimulating factor (G-CSF) on chronic myocardial ischemia in swine. BACKGROUND: We recently have reported that G-CSF prevents cardiac remodeling and dysfunction after acute myocardial infarction in mice and swine. It remains unclear whether G-CSF has beneficial effects on chronic myocardial ischemia. METHODS: An ameroid constrictor was placed on left circumflex coronary artery of swine. The presence of myocardial ischemia was verified at four weeks after the operation, and the animals were randomly assigned into the following two groups: 1) administration of vehicle (control group, n = 10), and 2) administration of G-CSF (10 microg/kg/day) for seven days (G-CSF group, n = 10). RESULTS: Echocardiographic examination revealed that the G-CSF treatment prevented left ventricular dilation and dysfunction at eight weeks after the operation. Stress echocardiography revealed that G-CSF ameliorated the regional contractility of chronic myocardial ischemia. Morphological analysis revealed that the extent of myocardial fibrosis of the ischemic region was less in the G-CSF group than in control group. There were more vessels and less apoptotic cells at the ischemic region of the heart of the G-CSF group than control group. Moreover, Akt1 was more strongly activated in the heart of the G-CSF group than control group. CONCLUSIONS: These findings suggest that G-CSF improves cardiac function of chronic myocardial ischemia through decreases in fibrosis and apoptotic death and an increase in vascular density in the ischemic region.

Heterogeneity of myocardial perfusion in distal coronary embolism with different particle sizes.

BACKGROUND: We hypothesized that altered myocardial perfusion distribution patterns could be seen with coronary distal emboli of different particle sizes using myocardial contrast echocardiography. METHODS: In 16 open-chest anesthetized dogs, microsphere suspensions of 9 or 500 microm in diameter were injected into the left anterior descending coronary artery until the mean left anterior descending coronary artery flow rate was reduced to less than 30% of baseline flow. During baseline conditions and after maximal embolization, real-time myocardial contrast echocardiography was performed by intravenous infusion of an echocontrast agent. RESULTS: In animals infused with 9-microm microspheres, a transmural perfusion defect was seen at the time of maximal embolization. In contrast, in animals infused with 500-microm microspheres, a subendocardial perfusion defect was observed. CONCLUSIONS: The particle size of coronary distal emboli affects myocardial perfusion distribution.

Physiologic assessment of coronary artery stenosis without stress tests: noninvasive analysis of phasic flow characteristics by transthoracic Doppler echocardiography.

We evaluated the significance of the diastolic-to-systolic blood flow velocity ratio (DSVR) determined by transthoracic Doppler echocardiography, for a physiologic assessment of the severity of coronary stenosis without stress tests, as compared with thallium 201 single photon emission computed tomography. In 95 patients undergoing thallium 201 single photon emission computed tomography for coronary artery disease, the flow velocity in the distal left anterior descending coronary artery was obtained with transthoracic Doppler echocardiography. The mean and peak DSVR values were calculated using mean and peak coronary flow velocity. DSVR was successfully measured for 82 patients (86.3%), including 33 patients with reversible perfusion defects in the left anterior descending coronary artery territories. For predicting reversible perfusion defects in thallium 201 single photon emission computed tomography, the best cut-off points were 1.5 for mean DSVR (sensitivity 81.8%, specificity 85.7%) and 1.6 for peak DSVR (sensitivity 75.7%, specificity 83.6%). Noninvasive measurement of DSVR with transthoracic Doppler echocardiography provides physiologic estimation of the left anterior descending coronary artery stenosis severity at high success rate, without stress tests.

Effect of mental stress on coronary flow velocity reserve in healthy men.

The effect of mental stress on coronary flow velocity reserve (CFVR) was examined in healthy men using transthoracic Doppler echocardiography. In the mental stress group (n = 31), CFVR was significantly reduced at 15 (to 3.3 +/- 0.8, p <0.001) and 30 (to 3.7 +/- 0.8, p <0.01) minutes after mental stress testing, compared with before mental stress (4.3 +/- 0.9), whereas it did not change in each of 3 measurements in control subjects (n = 10). Mental stress impaired coronary circulation even after a certain interval after the stress.

Assessment of regional myocardial strain by a novel automated tracking system from digital image files.

Myocardial strain imaging by Doppler tissue echocardiography is a useful method to quantify regional left ventricular function. However, this method has a problem of its Doppler angle dependency. We attempted to quantify myocardial strain by a newly developed automated tracking system from digital image files. In 6 anesthetized open-chest dogs, a pair of ultrasonic crystals was implanted at the inner site and outer site of the left ventricular wall to measure myocardial radial strain. B-mode echocardiographic images and trajectories of crystals were recorded simultaneously. Three conditions were examined by intravenous infusion of dobutamine. We used a pattern matching algorithm, which allowed us to track objects from one frame to the next. In 18 image sequences obtained in the 6 dogs, there was an excellent correlation in maximal myocardial strain between the two methods ( r = 0.92, P < .0001). Thus, this system is a promising tool to provide automated quantification of regional myocardial strain.

Acute effect of oral vitamin C on coronary circulation in young healthy smokers.

BACKGROUND: Recent studies suggest that smokers' coronary endothelial function is impaired because of increased oxidative stress, and their coronary flow velocity reserve (CFVR) is reduced. It is uncertain whether oral antioxidant vitamin C restores impaired CFVR in smokers. Recent technological advances in transthoracic Doppler echocardiography (TTDE) have resulted in the successful measurement of coronary flow velocity and noninvasive CFVR assessment. METHODS: We studied 13 healthy young male smokers and 12 nonsmokers. Coronary flow velocities in the left anterior descending coronary artery (LAD) were recorded with TTDE at rest and during hyperemia induced with intravenous infusion of adenosine triphosphate (ATP). CFVR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. CFVR and plasma concentrations of vitamin C were assessed at baseline and 2 and 4 hours after oral intake (2 g). RESULTS: Heart rate and blood pressure responses to ATP infusion were not affected by oral vitamin C, but plasma concentrations of vitamin C increased to physiological levels in both groups. CFVR was significantly higher in nonsmokers than in smokers at baseline (4.3 +/- 0.4 vs 3.8 +/- 0.8, P <.05). After oral vitamin C, it was increased significantly in smokers (3.8 +/- 0.8 to 4.5 +/- 0.7, P <.005, 4.5 +/- 0.8, P <.005, respectively), but not in nonsmokers (4.3 +/- 0.4 to 4.3 +/- 0.3, 4.4 +/- 0.7). CONCLUSIONS: This study demonstrated that oral vitamin C restores coronary microcirculatory function and impaired CFVR against oxidative stress in smokers.

Usefulness of rapid quantitative measurement of myoglobin and troponin T in early diagnosis of acute myocardial infarction.

BACKGROUND: New equipment, the Cardiac Reader(TM), which can measure blood concentrations of troponin T (T) and myoglobin (M) in only 15 min at the bedside was evaluated for early diagnosis of acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 34 consecutive patients with AMI who came to hospital within 24 h after onset were studied. Blood samples were collected from the patients at admission and 6, 12, 24, 48 h after onset to qualitatively and quantitatively measure T, M and creatine kinase-MB fraction. There were 20 patients with positive results by qualitative troponin T test and 29 with positive results by quantitative test. Of the patients who visited hospital within 3 h of onset, 17% were positive by the qualitative test and 67% cases had positive results in the quantitative test. The patients were divided into 2 groups according to the flow grade in the infarct-related coronary artery. In the TIMI 0-1 group (n=28), serum myoglobin concentrations were higher than in the TIMI 3-4 group (n=6) at admission and at their peak. CONCLUSION: The rapid quantitative test of T and M is useful for early diagnosis of AMI and as an indicator of its severity, which can be evaluated from the myoglobin concentration in the hyper-acute phase.

Evaluation of abnormal motion of interventricular septum after coronary artery bypass grafting operation: assessment by ultrasonic strain rate imaging.

We investigated whether strain rate imaging by echocardiography can quantify abnormal motion of interventricular septum (IVS) after coronary artery bypass grafting operation (CABG). Strain rate imaging was performed in 12 patients with angina pectoris treated by CABG; 12 patients with angina pectoris treated medically, with catheter intervention, or both (non-CABG); and 10 patients with previous anterior myocardial infarction. Peak systolic Doppler tissue velocity of mid-IVS was significantly lower in the CABG group than in the non-CABG group (2.15 +/- 0.58 cm/s vs 3.37 +/- 1.15 cm/s; P <.05). However, there was no significant difference in peak systolic strain (PSS) rate and PSS of mid-IVS between CABG and non-CABG groups. PSS rate and PSS of mid-IVS were significantly lower in the anterior myocardial infarction group than in the non-CABG group (-0.45 +/- 0.25/s vs -1.22 +/- 0.28/s and -5.8 +/- 4.9% vs -17.2 +/- 3.4%, respectively; P <.0001). Strain rate imaging can quantify accurate left ventricular function in cases of apparently reduced cardiac motion.