Myocardial inefficiency in asynchronous segmental early relaxation with exercise: A case series

Asynchronous segmental early relaxation phenomenon (ASERP) is a condition infrequently reported in exercise stress echocardiography and is characterised by sudden localised outward motion of the left ventricle during the isovolumic relaxation period. ASERP has been seen on angiographic studies at rest, which examined the extent of wall motion from end-diastolic and end-systolic frames. However, this method does not allow for an assessment of the timing of wall motion. With technological advances in echocardiography, advanced tools such as two-dimensional (2D) speckle-tracking and myocardial work, may allow for the precise timing and extent of ASERP to be more accurately identified during systole and diastole and provide assessment of myocardial performance. Two cases of ASERP are reported occurring in those with a high hemodynamic response and exaggerated systolic blood pressure response with exercise. The diagnostic characteristics of ASERP will be explored, including the use of 2D speckle-tracking and myocardial work.