Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program

Objectives. To assess the long‐term effects of chocolate consumption amongst patients with established coronary heart disease. Design. In a population‐based inception cohort study, we followed 1169 non‐diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants self‐reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years. Results. Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those never eating chocolate, the multivariable‐adjusted hazard ratios were 0.73 (95% confidence interval, 0.41–1.31), 0.56 (0.32–0.99) and 0.34 (0.17–0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality. Conclusions. Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large‐scale, long‐term, controlled randomized trials is needed.     

职业紧张--一个冠心病潜在危险因素的研究进展

职业紧张是指工作场所中的社会心理因素超出人体的调节能力时,或工作要求与能力、资源、需求不相匹配时所产生的有害的生理和心理反应。职业紧张已经成为重要的职业健康问题,并且成为经济损失的重要原因。职业紧张很可能是冠心病的一个新的危险因素,探讨职业紧张与冠心病的关系对于冠心病的预防有重要意义。     

Longitudinal association between cognitive depressive symptoms and D‐dimer levels in patients following acute myocardial infarction

BackgroundA prothrombotic tendency could partially explain the poor prognosis of patients with coronary heart disease and depression. We hypothesized that cognitive depressive symptoms are positively associated with the coagulation activation marker D‐dimer throughout the first year after myocardial infarction (MI).MethodsPatients with acute MI (mean age 60 years, 85% men) were investigated at hospital admission (n = 190), 3 months (n = 154) and 12 months (n = 106). Random linear mixed regression models were used to evaluate the relation between cognitive depressive symptoms, assessed with the Beck depression inventory (BDI), and changes in plasma D‐dimer levels. Demographics, cardiac disease severity, medical comorbidity, depression history, medication, health behaviors, and stress hormones were considered for analyses.ResultsThe prevalence of clinical depressive symptoms (13‐item BDI score ≥ 6) was 13.2% at admission and stable across time. Both continuous (p < .05) and categorical (p < .010) cognitive depressive symptoms were related to higher D‐dimer levels over time, independent of covariates. Indicating clinical relevance, D‐dimer was 73 ng/ml higher in patients with a BDI score ≥ 6 versus those with a score < 6. There was a cognitive depressive symptom‐by‐cortisol interaction (p < .05) with a positive association between cognitive depressive symptoms and D‐dimer when cortisol levels were high (p < .010), but not when cortisol levels were low (p > .05). Fluctuations (up and down) of cognitive depressive symptoms and D‐dimer from one investigation to the next showed also significant associations (p < .05).ConclusionsCognitive depressive symptoms were independently associated with hypercoagulability in patients up to 1 year after MI. Hypothalamic–pituitary–adrenal axis could potentially modify this effect.     

Association of interleukin 8 with myocardial infarction: Results from the Stockholm Heart Epidemiology Program

Background

Interleukin 8 (IL8) has been contradictorily associated with the risk of myocardial infarction (MI).

Aim

To investigate the association of IL8 serum levels with the risk of MI and the association of the IL8 (IL8) and IL8 receptors (CXCR1 and CXCR2) genetic variants with IL8 levels and MI risk in a large case control study, the Stockholm Heart Epidemiology Program.

Methods and results

IL8 levels (pg/mL) were divided into quartiles and the MI risk was calculated by logistic regression and expressed as odds ratio (OR) and 95% CI. Two IL8 SNPs (rs4073A/T, rs2227306C/T) and three SNPs tagging CXCR1 and CXCR2 (rs4674258C/T, rs1008563C/T, rs6723449T/C) were analyzed for association with IL8 levels and with MI risk.Multivariate adjusted ORs for MI risk by IL8 levels in the highest quartiles indicated reduced point estimates in both women (OR 0.37; 95% CI 0.2–0.8) and men when compared to the lowest quartile. In female cases, IL8 levels decreased progressively in the six months after MI (p = 0.03). IL8, CXCR1 and CXCR2 genetic variants were not associated with IL8 levels. In men, the T allele at the IL8 SNP rs4073 was associated with a slight increase in the MI risk under an additive and a recessive model of inheritance.

Conclusions

IL8 serum levels were associated with a reduced occurrence of MI among women, whereas IL8 was associated with a slightly increased risk among men, possibly through different mechanisms. These data suggest that the biological effects of IL8 on MI risk may vary over time and warrant further cohort studies with repetitive IL8 measurements.     

Exercise-induced symptomatic ischaemia predicts a poor long-term prognosis after acute myocardial infarction

STUDY OBJECTIVES: To evaluate the long-term prognostic significance of symptomatic ischaemia during exercise testing performed 3 weeks after acute myocardial infarction (AMI). DESIGN: A prospective study with long-term follow-up. SETTING: A Cardiac Rehabilitation Clinic in a University Hospital. SUBJECTS: A total of 446 patients were allowed to perform exercise testing 3 weeks after AMI and followed for 72 +/- 20 months. MEASUREMENTS AND RESULTS: Patients were divided into three groups according to whether they had no ECG evidence of ischaemia during exercise testing (334 patients), silent ischaemia (90 patients) or symptomatic ischaemia (22 patients). Cardiac death was significantly more frequent in patients with symptomatic ischaemia when compared with silent ischaemia (31.8% vs. 7.8%, P < 0.01) or when compared with no ischaemia (31.8% vs. 10.2%, P < 0.01). The three groups had a low cardiac mortality during the first 48 months of follow-up. The prognosis of patients with symptomatic ischaemia worsens markedly thereafter. The results of exercise testing did not predict recurrence of myocardial infarction. Coronary revascularization was performed in 34.4% of those without ischaemia, 47.8% of those with silent ischaemia and 45.5% of those with symptomatic ischaemia (P < 0.01). CONCLUSIONS: Patients with symptomatic ischaemia have a good prognosis during the first 4 years of follow-up. Their prognosis worsens thereafter as opposed to patients with or without silent ischaemia. This high-risk group of patients with symptomatic ischaemia deserves optimal management including revascularization when appropriate.     

急性多部位心肌梗死心电图与冠状动脉造影相关研究

３７例心电图确诊为急性多部位心肌梗死（ＡＭＩ）患者，前壁＋下壁或侧壁ＡＭ１２３例，下壁＋侧壁或后ＡＭＩ１４例。冠状动脉造影示单支血管病甲组１７例，乙组９例；多支血管病变甲组６例和乙组５例。甲组左心室室壁活动异常积分、临床心功能分级及死亡率均显著高于乙组。但单支血管病变患者与多支血管病变患者的左心室功能及心脏事件发生率无显著差异。因此，首次多部位ＡＭＩ时，单支血管病变多见，且在累及前壁时，常由左前降     

急性心肌梗死恢复期运动试验的价值

29例急性心肌梗死患者恢复期(31—81天)接受症状限制性平板运动试验。23例接受冠脉造影,22例接受左室造影。运动中ST段压低诊断多支病变的敏感性和特异性为60％与92％。低运动负荷结合运动中ST段压低诊断多支病变的敏感性和特异性为100％与67％;运动中收缩压反应异常结合ST段压低诊断多支病变的敏感性和特异性为80％与92％。广泛前壁梗死运动中ST段抬高者显著多于其他部位梗死。10例运动中ST段抬高者6例有室壁瘤形成。运动试验指标与超声心动图测得的左室射血分数无相关性。     

急性心肌梗死患者连续心率减速力的临床研究

目的探讨急性心肌梗死患者的连续心率减速力（heart rate deceleration runs,DRs）危险分层与心率减速力（deceleration capacity,DC）、心率变异性总标准差（SDNN）、左室射血分数（left ventricular ejection fraction,LVEF）以及冠状动脉狭窄程度之间的关系。方法38例急性心肌梗死患者和20例体检者接受24 h动态心电图和超声心动图检查,测定其DC值、DRs、HRV时域指标SDNN以及LVEF;对急性心肌梗死患者进行冠状动脉造影,记录冠脉狭窄程度。按照DRs结果分为低危组（17例）、中危组（15例）、高危组（6例）、对照组（20例）,比较4组间年龄、DC值、SDNN、LVEF及冠脉狭窄程度。结果①高危组的年龄比低危组明显增大,差异有统计学意义（P〈0.05）;②从对照组到高危组,DC值和SDNN值逐渐降低,高危组与其他3组相比明显降低,其差异有统计学意义（P〈0.05）;③DRs分层与冠脉狭窄程度无明显相关性。结论急性心肌梗死患者DRs分层和DC值、SDNN间有显著相关性,均能评估急性心肌梗死患者迷走神经张力,联合应用可提高心肌梗死后猝死的预警。     

Myocardial bridging: a cause of myocardial infarction?

A 50-year-old man was admitted to hospital because of severe and progressive chest pain at rest. Selective coronary arteriography revealed occlusion of the left anterior descending artery at the origin of an intramural course. Intracoronary thrombolysis restored the patency of the otherwise completely normal vessel but did not fully prevent myocardial infarction.     

Coronary occlusion: Cause or consequence of acute myocardial infarction?

A 45-year-old man with unstable angina developed persistent ECG changes of myocardial ischemia during coronary angiography. Occlusion of the left anterior descending branch (LAD) was documented 20 minutes after these changes. Intracoronary nitrate, Ca antagonist, urokinase, removal by percutaneous transluminal coronary angioplasty (PTCA) of atherosclerotic obstructions, and emergency bypass surgery failed to restore myocardial perfusion. Only short periods of reflow were obtained by urokinase and PTCA. The repeated coronary injections demonstrated a progressive disappearance of the left anterior descending artery (LAD) starting from the distal portion and progressing retrogradely up to the origin of the vessel. The patient developed a transmural anterolateral myocardial infarction and 12 months later underwent cardiac transplantation for untractable failure. His heart was examined and the infarct confirmed. Analysis of this case suggests that coronary occlusion in acute myocardial infarction can be an event secondary to increased intramyocardial resistance rather than the cause of reduced coronary blood flow in subepicardial coronary arteries.     

New-onset angina preceding acute myocardial infarction is associated with improved contractile recovery after thrombolysis

Background Ischaemic preconditioning reduces myocardial infarct size inanimal models. Clinical data suggest that episodes of anginaimmediately before acute myocardial infarction may be associatedwith smaller infarct size in man. However, it is unclear whetherischaemic episodes preceding acute myocardial infarction alsoaffect contractile recovery in patients. Objective In this study we investigated the recovery of regional myocardialfunction after thrombolysis in two groups of patients at theirfirst Q-wave acute myocardial infarction; in one group (n=42)myocardial infarction occurred unheralded, whereas patientsof the second group (n=48) had experienced new-onset anginain the 48h that preceded infarction. Echocardiographic analysisof myocardial regional function in the infarct area was doneat 2, 24 and 72h after thrombolysis, and at 1 week, and 1 and3 months follow-up. Results Peak level of MB-creatine kinase was significantly lower inpatients with new-onset angina (96±47 as compared with221±108IU.l^–1, P<0·01), as was the areaunder the MB-creatine kinase curve (1321±876 as comparedto 3879±1555U.l^–1/36h, P<0·01). Hypokineticsegments were fewer in patients with pre-infarction angina.Similarly, wall motion score improved significantly earlierin patients who had new-onset angina before acute myocardialinfarction. Thus, contractile recovery was more rapid in patientswith previous angina than in those in whom infarction occurredunheralded. Complications during the in-hospital outcome andother variables considered during the 4-week follow-up weresimilar between groups. Conclusions Patients who experienced new-onset angina before acute myocardialinfarction showed better recovery of regional function afterthrombolysis. Our study supports the hypothesis that brief periodsof ischaemia immediately before myocardial infarction may preconditionthe human heart, thus improving contractile recovery.     

Decreased level of melatonin in serum predicts left ventricular remodelling after acute myocardial infarction

Abstract: As experimental studies suggest that melatonin is cardioprotective after myocardial infarction (MI), this study sought to investigate the relationships between circulating levels of melatonin and left ventricular (LV) remodelling in patients after acute MI. This prospective study included 161 patients (age 61 ± 3 yr; 78% men) undergoing primary percutaneous coronary intervention who were assessed echocardiographically at hospital discharge (day 3–7) and at 12 months. LV remodelling was defined as >20% increase in LV end‐diastolic volume at 12‐month follow‐up compared with baseline. Serum melatonin concentrations were measured at admission, during the light period. Twenty‐four patients showed LV remodelling, and 137 had no evidence of LV remodelling. Patients with LV remodelling had lower levels of melatonin at study entry [9.96 (8.28–11.03) versus 16.74 (13.77–19.59) pg/mL, respectively; P < 0.0001]. Multivariate analysis showed that melatonin levels (OR = 2.10, CI 95% 1.547–2.870, P < 0.001) were an independent predictor of LV remodelling at 12‐month follow‐up. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.959 (CI 95% 0.93–0.98; P < 0.0001). To our knowledge, this is the first study to show the relationship between melatonin and LV remodelling during the chronic phase post‐MI.     

Job conditions and fibrinogen in 14226 Belgian workers: the Belstress study.

AIMS: To investigate the relationship between fibrinogen and stressful work conditions, where perceived strain is defined by the simultaneous presence of high psychological demands and low control, according to Karasek's Demand/Control/(Social Support) model. METHODS AND RESULTS: A cross-sectional study was realized between 1994 and 1998 in 24 Belgian enterprises, on 16335 male and 5084 female middle-aged workers of different Belgian companies participating in the Belstress study. This study confirmed the well-documented bivariate relationship between plasma fibrinogen levels and gender, age, educational level, smoking, obesity, physical activity, alcohol consumption, total cholesterol, HDL-cholesterol, arterial hypertension and diabetes. No independent multivariate relationship was observed between job control, psychological job demands or social support at work and plasma fibrinogen, but after stratification a positive association (P< or =0.05) was observed between psychological job demands and plasma fibrinogen for males in the lowest educational level. Moreover a positive statistically significant association between job strain and plasma fibrinogen was observed in males but not in females. After stratification for educational level this association remained significant for males especially in the lowest educational level (P< or =0.001) and became significant for females in the middle educational level. CONCLUSIONS; As suggested in our study and others, plasma fibrinogen could be one of the potential mediators explaining the relationship between job stress and coronary heart disease.     

Primary risk factors influence risk of recurrent myocardial infarction/death from coronary heart disease: results from the Stockholm Heart Epidemiology Program (SHEEP).

BACKGROUND: Prognosis after a first myocardial infarction (MI) is influenced by primary risk factors as well as secondary risk factors. There is still a lack of follow-up studies of well-characterized patient cohorts assessing the relative importance of these factors. DESIGN: A cohort of 1635 patients (aged 45-70 years) surviving at least 28 days after a first MI were followed for 6-9 years with regard to recurrent MI/fatal coronary heart disease (CHD). Data were collected through questionnaires, physical examinations, and medical records. METHODS: Hazard ratios (HR) with 95% confidence intervals (CI) for different risk factors were calculated using the Cox proportional hazard model. RESULTS: Of the primary risk factors, diabetes in both sexes was the most important predictor of recurrent MI/fatal CHD, multivariate-adjusted HR in men 1.6 (95% CI; 1.0-2.4) and in women 2.5 (95% CI; 0.9-6.9). Other primary risk factors with prognostic influence were job strain, HR 1.5 (95% CI; 1.0-2.1), and central obesity, HR 1.4 (95% CI; 1.0-2.0), in men and a low level of apolipoprotein A1, HR 2.3 (95% CI; 1.1-5.0), and high-density lipoprotein cholesterol, HR 1.9 (95% CI; 0.9-4.1), in women. The secondary risk factors most detrimental for prognosis were heart failure in men, HR 2.2 (95% CI; 1.2-4.0), and a high peak acute cardiac enzyme level in women, HR 4.4 (95% CI; 2.0-9.7). CONCLUSIONS: Long-term follow-up of patients who survived at least 28 days after a first MI shows that several primary cardiovascular risk factors, particularly diabetes, contribute to the increased risk of recurrent MI/fatal CHD.     

急性心肌梗死合并糖尿病患者血浆B型钠尿肽水平预测主要心脏不良事件的价值

目的探讨合并糖尿病的急性心肌梗死(AMI)患者的血浆N末端前体B型钠尿肽(NT-proBNP)水平对主要心脏不良事件(MACE)的预测价值。方法选择冠心病(AMI)患者139例,根据诊断分为AMI合并糖尿病组(合并组)73例,AMI组66例,另选择同期住院的非冠心病患者64例作为对照组,采用化学发光法检测血浆NT-proBNP水平,分析NT-proBNP判断6个月后MACE的发生率。结果合并组血浆NT-proBNP水平显著高于AMI组和对照组[(796.7±256.4)ng/L vs(642.5±231.5)ng/L和(89.6±103.3)ng/L,P<0.05,P<0.01],血浆NT-proBNP水平与冠状动脉造影Gensini评分呈正相关(r=0.726,P<0.01),合并组NT-proBNP>920ng/L的患者6个月MACE发生率较≤920ng/L者明显增高(60.0%vs 15.2%,P<0.01)。结论血浆NT-proBNP水平与AMI合并糖尿病患者的病情严重程度有一定的相关性。     

Drinking pattern and risk of non-fatal myocardial infarction: a population-based case-control study

Aims Alcohol consumption has been associated with a reduced risk of heart disease incidence and mortality. However, most studies have focused on an average volume per specific time period and have paid little attention to the pattern of drinking. The aim of this study was to examine the association between various drinking patterns and myocardial infarction (MI). Design A population‐based case–control study. Methods Participants were 427 white males with incident MI and 905 healthy white male controls (age 35–69 years) selected randomly from two Western New York counties. During computer‐assisted interviews detailed information was collected regarding patterns of alcohol consumption during the 12–24 months prior to interview (controls) or MI (cases). Findings Compared to life‐time abstainers, adjusted odds ratios (ORs) and 95% confidence interval (CI) for non‐current and current drinkers were 0.66 (0.31–1.39) and 0.50 (0.24–1.02), respectively. Daily drinkers exhibited a significantly lower OR (0.41) compared to life‐time abstainers. Participants who drank mainly without food had an OR of 1.49 (0.96–2.31) compared to those who drank mainly with food and 0.62 (0.28–1.37) compared to life‐time abstainers. Men who reported drinking only at weekends had a significantly greater MI risk [1.91; (1.21–3.01)] compared to men who drank less than once/week, but not compared to life‐time abstainers [0.91 (0.40–2.07)]. Conclusions Our results indicate that patterns of alcohol use have important cardiovascular health implications.     

Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies

Abstract. Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB, Bonenfant S, Borritz M, Burr H, Casini A, Clays E, Dragano N, Erbel R, Geuskens GA, Goldberg M, Hooftman WE, Houtman IL, Jöckel K‐H, Kittel F, Knutsson A, Koskenvuo M, Leineweber C, Lunau T, Madsen IEH, Magnusson Hanson LL, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pentti J, Rugulies R, Siegrist J, Suominen S, Vahtera J, Virtanen M, Westerholm P, Westerlund H, Zins M, Ferrie JE, Theorell T, Steptoe A, Hamer M, Singh‐Manoux A, Batty GD, Kivimäki M, for the IPD‐Work Consortium (Finnish Institute of Occupational Health, Helsinki, Finland; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Jönköping University, Jönköping, Sweden; Ghent University, Ghent, Belgium; National Research Centre for the Working Environment, Copenhagen, Denmark; Versailles‐Saint Quentin University, Versailles, France; Centre for Research in Epidemiology and Population Health, Villejuif, France; Bispebjerg University Hospital, Copenhagen, Denmark; Centre for Maritime Health and Safety, Esbjerg, Denmark; Université Libre de Bruxelles, Brussels, Belgium; University Duisburg‐Essen, Essen, Germany; West‐German Heart Center Essen, University Duisburg‐Essen, Essen, Germany; TNO, Hoofddorp, the Netherlands; Mid Sweden University, Sundsvall, Sweden; University of Helsinki, Helsinki, Finland; Stockholm University, Stockholm, Sweden; University College London, London, UK; Bispebjerg University Hospital, Copenhagen, Denmark; Umeå University, Umeå, Sweden; Finnish Institute of Occupational Health, Turku, Finland; Harvard School of Public Health, Boston, MA, USA; University of Copenhagen, Copenhagen, Denmark; University of Düsseldorf, Düsseldorf, Germany; University of Turku, Turku; Folkhälsan Research Center, Helsinki; Turku University Hospital, Turku, Finland; Uppsala University, Uppsala; Karolinska Institutet, Stockholm, Sweden; University of Bristol, Bristol; University of Edinburgh, Edinburgh, UK; and University of Helsinki, Helsinki, Finland). Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies. J Intern Med 2012; 272 : 65–73. Background. Evidence of an association between job strain and obesity is inconsistent, mostly limited to small‐scale studies, and does not distinguish between categories of underweight or obesity subclasses. Objectives. To examine the association between job strain and body mass index (BMI) in a large adult population. Methods. We performed a pooled cross‐sectional analysis based on individual‐level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow‐up of 4 years was possible for four cohort studies (n = 42 222). Results. A total of 86 429 participants were of normal weight (BMI 18.5–24.9 kg m^?2), 2149 were underweight (BMI < 18.5 kg m^?2), 56 572 overweight (BMI 25.0–29.9 kg m^?2) and 13 523 class I (BMI 30–34.9 kg m^?2) and 3073 classes II/III (BMI ≥ 35 kg m^?2) obese. In addition, 27 010 (17%) participants reported job strain. In cross‐sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00–1.25], obese class I (odds ratio 1.07, 95% CI 1.02–1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01–1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow‐up. Conclusions. In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a ‘U’‐shaped cross‐sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.     

Transmural myocardial strain gradient: a new and robust quantitative index of left ventricular wall motion based on myocardial strain imaging

Background: Peak strain has been promising as an index of wall motion but it is sometimes susceptible to the image quality. Objective: We investigated the feasibility of a novel index, transmural myocardial strain gradient (TMSG), derived from myocardial strain M‐mode imaging (TDI‐Q, Toshiba) for quantifying regional systolic wall motion. Method: We measured transmural myocardial strain distribution at the left ventricular lateral, posterior, inferior, septal, anteroseptal and anterior walls in the basal and midventricular short‐axis images using TDI‐Q. Twenty normals (35 ± 3 years) and 35 consecutive patients (63 ± 9 years) with coronary artery disease (CAD, 19 patients with old myocardial infarction, 4 patients with acute myocardial infarction, 12 patients with angina pectoris) were studied. Peak strain, endocardial‐ and epicardial‐half strain and TMSG ((peak strain, ? epicardial strain)/distance between peak and epicardial points) were obtained. Coefficient of variation (CV) of each index was calculated. Results: In control subjects, the best reproducibility of the variables was obtained for TMSG with the smallest CV (11.6%) (27.8%, 28.1%, and 35.5%, respectively for CV of peak strain, endocardial‐ and epicardial‐half strain). All segments in control subjects and normal segments in CAD patients showed no significant difference in TMSG (15.1 ± 1.8 vs. 15.1 ± 1.6%/mm, P = ns). TMSG was the lowest for akinetic segments and highest for the normal segments (P < 0.001). Conclusion: TMSG was more robust than simple strain values to quantitatively assess wall motion. This could successfully identify subtle regional differences in wall function. (Echocardiography 2011;28:181‐187)