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Effect of Ca2+ on GP IIb-IIIa interactions with integrilin: enhanced GP IIb-IIIa binding and inhibition of platelet aggregation by reductions in the concen- tration of ionized calcium in plasma anticoagulated with citrate. Circulation 1997;96:1488 –1494. Evaluation of Whole Left Ventricular Systolic Performance and Local Myocardial Systolic Function in Patients With Prior Myocardial Infarction Using Global Long-Axis Myocardial Strain Nobuyuki Ohte, MD, Hitomi Narita, MD, Hiromichi Miyabe, MD, Norio Takada, MD, Toshihiko Goto, MD, Hiroumi Mizuno, MD, Kaoru Asada, MD, Junichiro Hayano, MD, and Genjiro Kimura, MD Left ventricular (LV) global strain along its long axis during systole, which is obtained by dividing mitral annular excursion by the distance from the mitral annulus to the LV apex at end-diastole, can be used to assess whole LV systolic performance. The evaluation of LV wall function using this parameter suggests that previous myocardial infarction (MI) causes long-axis myocardial function in remote normal LV walls, as well as in walls with MI, to deteriorate. 2004 by Excerpta Medica, Inc. (Am J Cardiol 2004;94:929 –932) S everal investigators have demonstrated that mitral annular longitudinal excursion during left ventric- ular (LV) systole correlates significantly with the LV ejection fraction. 1–3 However, mitral annular displace- ment depends not only on LV systolic performance but also on LV size, with larger left ventricles having greater displacements than smaller left ventricles. We propose a new parameter of LV systolic performance, global systolic LV long-axis strain, which is indepen- dent of LV size. Global systolic LV long-axis strain should be a more appropriate parameter of LV systolic performance than mitral annular excursion during sys- tole. 4,5 This systolic LV long-axis strain enables the evaluation of the longitudinal myocardial contractile function of any particular LV wall. ••• Subjects were 75 patients who underwent cardiac catheterization for evaluation of suspected chronic coro- nary artery disease. Fifty-four were men and 21 were women (mean age was 65  9 years). Thirty-eight patients had previous myocardial infarctions (MIs), and 22 had angina pectoris. Previous MI was diagnosed on the basis of the extension of localized LV wall motion abnormality using biplane contrast left ventriculography with related electrocardiographic changes. Reduced wall motion on the anterior and/or septal walls was defined as an anterior MI and on the inferior and/or posterolateral walls as an inferior MI. In patients with previous MIs, 22 were diagnosed as having anterior MIs, 9 as having inferior MIs, and 7 as having combined anterior and inferior MIs. The remaining 15 patients with normal left ventriculographic results and without significant coro- nary artery stenosis were diagnosed as having atypical chest pain. All patients gave written informed consent before participation in the study. The study was per- formed according to the regulations proposed by the Ethical Guidelines Committee of Nagoya City Univer- sity Graduate School of Medical Sciences. Echocardiography was performed using a Powervi- sion 6000 (Toshiba Medical Corporation, Tokyo, Japan) with a 2.5-MHz transducer. In each patient, a LV apical 4-chamber view was obtained using the tissue harmonic mode and recorded on a computer system for echocardiographic image analysis (UIWS-300A, Toshiba Medical Corporation). Mitral annular excur- sions at the septal and lateral corners of the mitral annu- lus toward the LV apex during systole and the distance along the inner surface of the LV chamber from each From the Department of Internal Medicine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Dr. Ohte’s address is: Department of Internal Medi- cine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. E-mail: ohte@med.nagoya-cu.ac.jp Manuscript received April 5, 2004; revised manuscript received and accepted June 15, 2004. 929 ©2004 by Excerpta Medica, Inc. All rights reserved. 0002-9149/04/$–see front matter The American Journal of Cardiology Vol. 94 October 1, 2004 doi:10.1016/j.amjcard.2004.06.031