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Doppler assessment of left ventricular diastolic filling during brief coronary occlusion
B de Bruyne1, R Lerch, B Meier
1Cardiology Center, University Hospital, Geneva, Switzerland.
Insights
Patients with coronary artery disease show altered left ventricular diastolic filling patterns. Acute ischemia further impairs early filling, with compensatory increases in late diastolic filling.
Area of Science:
- Cardiology
- Diabetology
Background:
- Single-vessel coronary artery disease (CAD) can affect cardiac function.
- Assessing diastolic filling is crucial for understanding cardiac health.
Purpose of the Study:
- To evaluate left ventricular diastolic filling in patients with single-vessel CAD.
- To investigate the impact of acute ischemia on diastolic function.
Main Methods:
- Doppler-derived transmitral velocity was measured in 22 normal subjects and 15 patients with isolated left anterior descending (LAD) stenosis.
- Measurements were taken before and during acute ischemia induced by balloon inflation in coronary angioplasty.
Main Results:
- Patients with LAD stenosis exhibited altered transmitral velocity patterns at baseline, with reduced early diastolic filling (E area) and increased late diastolic filling (A area).
- The E/A area ratio was decreased, and the A area/total area ratio was increased in patients compared to controls.
- Acute ischemia further decreased E area and E/A ratio, while increasing A area and A area/total area.
Conclusions:
- Altered transmitral velocity patterns are common in single-vessel CAD patients, even without overt ischemia.
- Acute regional ischemia exacerbates diastolic dysfunction, characterized by compromised early filling and enhanced late filling.
Abstract:
To assess left ventricular diastolic filling in patients with single-vessel coronary artery disease, Doppler-derived transmitral velocity was studied in 22 normal subjects and in 15 patients with isolated proximal stenosis of the left anterior descending coronary artery (LAD) and normal systolic function of the left ventricle. Transmitral velocity was recorded before and after balloon inflation during coronary angioplasty. At baseline the transmitral velocity pattern in patients with LAD stenosis differed from that of normal subjects with a significant (p at least less than 0.05) decrease in the early diastolic filling phase (E area 0.094 +/- 0.022 m in normal subjects vs 0.078 +/- 0.008 m in patients) and an increase in the late diastolic filling phase (A area 0.034 +/- 0.007 m vs 0.042 +/- 0.008 m). Correspondingly the ratio E area/A area decreased (2.7 +/- 0.51 vs 1.9 +/- 0.4) and the ratio A area/total area increased (0.28 +/- 0.04 vs 0.35 +/- 0.05). During coronary occlusion the E area and the ratio E area/A area decreased further, whereas the A area and the ratio A area/total area increased. The results suggest that patients with single-vessel disease and normal systolic function often exhibit an altered pattern of transmitral velocity even in the absence of overt ischemia, and that during acute regional ischemia early diastolic filling is further compromised with compensatory enhancement of the late diastolic filling phase.