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[Left ventricular diastolic function in PTCA: a Doppler echocardiographic study]
H W Lange1, M Schlüter, C Hamm
1Kardiologische Abteilung, Medizinischen Klinik, Universitätskrankenhaus Eppendorf, Hamburg.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) temporarily impairs left ventricular diastolic function, reducing early filling. This diastolic dysfunction is fully reversible within 60 seconds after the procedure, as shown by Doppler echocardiography.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Context:
- Doppler echocardiography non-invasively assesses diastolic function.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common cardiac procedure.
- Left ventricular diastolic function can be affected by coronary interventions.
Purpose:
- To evaluate changes in left ventricular diastolic function during PTCA of the left anterior descending coronary artery (LAD).
- To assess the reversibility of diastolic dysfunction post-PTCA.
Summary:
- Doppler echocardiography measured mitral valve diastolic flow velocity in ten patients before, during, and after LAD PTCA.
- During balloon inflation, peak early diastolic filling velocity (VE) decreased significantly (p<0.001), and total filling volume reduced (p<0.001).
- Diastolic velocity ratio (VE/VA) and early filling fraction decreased, while atrial filling fraction increased (p<0.01), with all parameters returning to baseline post-deflation.
Impact:
- PTCA of the LAD induces transient diastolic dysfunction, characterized by reduced early diastolic filling.
- The observed diastolic dysfunction is completely reversible within 60 seconds after balloon deflation.
- Doppler echocardiography is effective in monitoring acute hemodynamic changes in diastolic function during interventional cardiology procedures.
Abstract:
The measurement of left ventricular inflow by Doppler echocardiography provides a continuous, non-invasive assessment of parameters of diastolic function. We studied changes in left ventricular diastolic function during percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending coronary artery (LAD). In ten patients, the diastolic flow velocity profile across the mitral valve was measured by Doppler echocardiography, before and 60 s after inflation and 60 s after deflation of the balloon. The peak velocity of early diastolic filling (VE) significantly decreased during angioplasty, from 68 +/- 12 to 56 +/- 10 cm/s (p less than 0.001), while the peak velocity of late diastolic filling caused by atrial contraction (VA) showed no change. This resulted in a significant decline in the diastolic velocity ratio (VE/VA) from 1.11 +/- 0.47 to 0.92 +/- 0.35 (p less than 0.01). The total area under the diastolic flow velocity profile representing the total filling volume fell from 14.3 +/- 4.1 to 10.9 +/- 3.6 cm (p less than 0.001). The early diastolic filling fraction decreased from 68 +/- 5% to 64 +/- 7%, in favor of the filling fraction due to atrial contraction, which increased from 32 +/- 5%, to 36 +/- 7% (p less than 0.01). 60 s after deflation of the balloon, the parameters of diastolic filling returned to baseline values. We conclude from our results that diastolic dysfunction caused by angioplasty of the LAD results in a decrease in early diastolic left ventricular filling, which is completely reversible after 60 s.