Related Experiment Videos
Diastolic function in patients undergoing coronary angioplasty: influence of degree of revascularization
R Castello1, A C Pearson, M J Kern
1Department of Internal Medicine, St. Louis University School of Medicine, Missouri.
Insights
Successful coronary angioplasty significantly improves left ventricular diastolic filling patterns within 24 hours. Complete revascularization further enhances early filling acceleration, suggesting improved relaxation is key.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Coronary artery disease impairs left ventricular (LV) diastolic function.
- Coronary angioplasty aims to restore blood flow and improve cardiac function.
- Early assessment of diastolic filling post-angioplasty is crucial for understanding treatment efficacy.
Purpose of the Study:
- To evaluate the immediate effects of successful coronary angioplasty on Doppler-derived LV filling patterns.
- To determine if the extent of revascularization influences these early changes.
Main Methods:
- Doppler echocardiography was used to assess LV filling in 31 patients before and 24 hours after coronary angioplasty.
- Key diastolic parameters including peak early to late velocity ratio, filling fraction, atrial contribution, pressure half-time, and isovolumetric relaxation time were measured.
- Patients were categorized based on complete versus incomplete revascularization.
Main Results:
- Successful angioplasty significantly improved LV diastolic filling, evidenced by increased peak early to late velocity ratio and one-third filling fraction.
- LV diastolic function showed improvement with decreased atrial contribution, shortened pressure half-time, and reduced isovolumetric relaxation time.
- While overall improvements were seen in both complete and incomplete revascularization groups, enhanced early filling acceleration was significant only in the complete revascularization group.
Conclusions:
- Successful coronary angioplasty rapidly modifies LV diastolic filling patterns within 24 hours.
- The primary mechanism appears to be improved LV relaxation.
- Complete revascularization may offer additional benefits in enhancing early diastolic filling dynamics.
Abstract:
To assess the early effects of successful coronary angioplasty on Doppler-derived left ventricular filling patterns and the significance of the extent of revascularization on these variables, 31 patients undergoing coronary angioplasty were examined within 24 h before and after the revascularization procedure. After angioplasty, the peak early to late velocity ratio increased from 0.89 +/- 0.2 to 1.05 +/- 0.3 (p less than 0.0001) and the one-third filling fraction increased from 42 +/- 10% to 48 +/- 10% (p less than 0.0001). The percent atrial contribution to filling decreased from 45 +/- 7% to 41 +/- 8% (p less than 0.01), and the pressure half-time and the isovolumetric relaxation time shortened from 55 +/- 15 to 43 +/- 13 ms (p less than 0.001) and from 100 +/- 14 to 82 +/- 17 ms (p less than 0.0001), respectively. When comparing patients with complete (n = 23) and incomplete (n = 8) revascularization, the same changes in the Doppler variables were observed. However, the mean rate of acceleration of early filling increased significantly after angioplasty only in those patients with complete revascularization. These data indicate that the left ventricular diastolic filling pattern is modified significantly as early as 24 h after successful coronary angioplasty. Improvement in impaired relaxation appears to be the most likely explanation for these changes, although increased myocardial stiffness in patients with incomplete revascularization is an alternative hypothesis.