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(Chest. 2004;125:1218-1223.)
© 2004 American College of Chest Physicians

Segmental Early Relaxation Phenomenon*

Incidence, Clinical Characteristics, and Significance in Stress Echocardiography

Omar Obeidat, MD; Muhammed Arida, MD; Mouaz Al-Mallah, MD; Mohsin Alam, MD and Karthik Ananthasubramaniam, MD

* From Henry Ford Heart and Vascular Institute, Detroit, MI.

Correspondence to: Karthik Ananthasubramaniam, MD, Henry Ford Hospital, Heart and Vascular Institute, 2799 West Grand Blvd, K-14, Detroit MI 48202; e-mail: vanji{at}pol.net

Study objectives: To evaluate the incidence, patient characteristics, and clinical significance of segmental early relaxation phenomenon (SERP) in stress echocardiography.

Design: Retrospective interpretation of digitized rest/stress echocardiographic images of 244 consecutive patients undergoing exercise or dobutamine echocardiography with subsequent patient follow-up for outcomes.

Setting: Tertiary care referral center.

Patients: Two hundred forty-four consecutive patients referred for stress echocardiography (exercise or dobutamine) for various clinical indications.

Interventions: None.

Measurements and results: SERP was diagnosed as a sudden outward motion of a portion of the left ventricle during early diastole (using frame-by-frame analysis) after peak systole prior to mitral valve opening at rest and after stress. Stress-associated SERP was observed in 71 patients (29.1%), with 25 patients having SERP in more than one segment. Five patients had resting SERP, with two persisting during stress. Ninety-six of 3,658 analyzed segments were positive for SERP. The apical septum and midseptum were most commonly involved in 49% and 18%, respectively. Only 5 of 96 patients (5.2%) had new hypokinesis and SERP in the same segment. No significant differences existed in demographic, clinical, or echocardiographic variables in patients with and without SERP. Follow-up revealed no significant differences in event rates in those with and without SERP.

Conclusions: This is the first stress echocardiographic study demonstrating that SERP is a distinct and relatively common stress echocardiographic phenomenon occurring in early diastole regardless of type of stress. SERP occurs predominantly in apical and midseptum in the distribution of the left anterior descending coronary artery. It should not be mistaken for atypical septal motion, ischemia, or dyskinesia, and does not seem related solely to the presence of underlying coronary disease or stress-induced ischemia. No adverse long-term outcomes are seen in patients with SERP and no inducible ischemia.

Key Words: asynchronous relaxation • diastole • ischemia • segmental early relaxation • stress echocardiography






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