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Impaired tissue Doppler diastolic function in patients with coronary artery disease: relationship to endothelial

Kaeng W Lee1, Andrew D Blann, Gregory Y H Lip

  • 1University Department of Medicine, City Hospital, Birmingham, UK.

American Heart Journal
|October 8, 2005
PubMed

Insights

In coronary artery disease (CAD), diastolic dysfunction is linked to endothelial damage and platelet activation, independent of systolic function. Tissue Doppler imaging (TDI) better reflects these changes than transmitral flow indexes.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Pulsed tissue Doppler imaging (TDI) assesses left ventricular systolic and diastolic function.
  • Coronary artery disease (CAD) patients may exhibit impaired diastolic function due to ischemia, potentially linked to endothelial dysfunction and thrombogenesis.
  • This study investigates the relationship between TDI-defined diastolic dysfunction and markers of endothelial damage (von Willebrand factor), platelet activation (soluble P-selectin), and thrombogenesis (D dimer, fibrinogen, plasma viscosity) in CAD.

Purpose of the Study:

  • To explore the association between diastolic dysfunction measured by TDI and specific plasma hemostatic markers in patients with CAD.
  • To determine if TDI-derived diastolic dysfunction correlates with endothelial damage, platelet activation, and thrombogenesis markers.
  • To compare the sensitivity of TDI-derived indexes versus transmitral flow indexes in reflecting these hemostatic changes in CAD.

Main Methods:

  • 75 stable CAD patients and 40 healthy controls underwent conventional Doppler echocardiography and TDI.
  • Global systolic (Sm) and diastolic (Em, Am) mitral annular velocities were averaged from four sites.
  • Plasma levels of von Willebrand factor (vWf), soluble P-selectin (sP-sel), D dimer, fibrinogen, and plasma viscosity (PV) were measured and correlated with TDI velocities dichotomized by median values.

Main Results:

  • CAD patients showed significantly lower Sm, Em, Em/Am ratio, and higher E/Em compared to controls (P < .05).
  • Multivariate analysis revealed significant differences in vWf, sP-sel, and fibrinogen between low and high TDI index groups, independent of systolic function.
  • D-dimer levels and transmitral flow indexes were not independently related to the measured hemostatic markers.

Conclusions:

  • Diastolic dysfunction in CAD patients is closely associated with increased platelet activation and endothelial damage/dysfunction.
  • These associations are independent of systolic left ventricular function.
  • TDI-derived diastolic indexes are more sensitive indicators of plasma hemostatic markers in middle-aged CAD patients compared to transmitral flow indexes.
Abstract

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