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Published on: December 15, 2023
The effect of postural changes (leg lifting) on tissue Doppler parameters in coronary artery disease
Bahar Pirat1, Aylin Yildirir, Vahide Simşek
1Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey. baharp@baskent-ank.edu.tr
Insights
Leg lifting altered tissue Doppler parameters similarly in patients with and without coronary artery disease (CAD), except for a blunted S wave in CAD patients. Decreased isovolumic acceleration rate (IVA) may indicate CAD.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Coronary artery disease (CAD) affects myocardial function.
- Tissue Doppler echocardiography (TDE) assesses diastolic and systolic function.
- Assessing myocardial response to preload changes can reveal subtle functional deficits.
Purpose of the Study:
- To evaluate the impact of increased preload via leg lifting on TDE parameters.
- To compare these effects in patients with and without CAD.
- To identify TDE markers indicative of CAD.
Main Methods:
- 42 patients underwent TDE at baseline and during leg lifting.
- Patients were categorized into CAD (stenosis >70%) and control groups.
- Tissue Doppler imaging assessed mitral annular velocities and isovolumic acceleration rate (IVA).
Main Results:
- Patients with CAD showed significantly lower baseline IVA at lateral and septal mitral annuluses.
- Leg lifting increased systolic velocity (S) in controls and significantly at the septal annulus in CAD patients.
- No significant change in IVA was observed after leg lifting in either group.
Conclusions:
- Preload alteration by leg lifting demonstrated similar TDE changes in both groups, except for blunted S wave augmentation at the lateral annulus in CAD patients.
- Reduced baseline IVA may serve as a diagnostic indicator for CAD.
Objectives:
We investigated the effect of increased preload through postural changes (leg lifting) on tissue Doppler parameters in patients with and without coronary artery disease (CAD).
Study Design:
The study included 42 patients who were scheduled for coronary angiography. All the patients underwent standard two-dimensional, color Doppler and tissue Doppler echocardiography before coronary angiography. Tissue Doppler imaging was performed from septal and lateral mitral annuluses at baseline and during 45 degrees leg lifting followed by two-minute stabilization. Patients were grouped based on coronary angiography findings: those having stenosis greater than 70% were considered to have CAD and those with normal coronary arteries comprised the control group. Echocardiography measurements were compared between the two groups.
Results:
Angiography showed normal coronary arteries or border irregularities in 22 patients and CAD in 20 patients. The two groups were similar with regard to demographic data and ejection fractions, except for male preponderance in the CAD group. Compared with the control group, patients with CAD exhibited a significantly lower isovolumic acceleration rate (IVA) at the lateral (p=0.007) and septal (p=0.03) mitral annuluses. In the control group, leg lifting resulted in increased systolic velocity (S) compared with baseline at the lateral (p=0.009) and septal (p=0.01) annuluses, whereas S wave augmentation was only significant at the septal annulus (p=0.009) in patients with CAD. No significant change was observed in IVA following leg lifting in both groups.
Conclusion:
Preload alteration induced by leg lifting resulted in similar changes in tissue Doppler parameters in patients with and without CAD, except for blunted augmentation of S wave at the lateral annulus in CAD. Detection of decreased IVA at baseline may be a useful finding for CAD.
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