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Effects of changes in coronary stenosis on left ventricular diastolic filling assessed with pulsed Doppler
T Masuyama1, K Kodama, S Nakatani
1Cardiovascular Division, Osaka Police Hospital, Japan.
Insights
Percutaneous transluminal coronary angioplasty improved left ventricular diastolic filling in patients with coronary stenosis. Echocardiography can noninvasively assess changes and predict restenosis.
Area of Science:
- Cardiology
- Echocardiography
- Vascular Medicine
Background:
- Coronary stenosis impacts left ventricular diastolic filling.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common intervention for coronary stenosis.
- Assessing diastolic function post-PTCA is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effects of coronary stenosis changes on left ventricular diastolic filling.
- To assess diastolic filling before and after PTCA using pulsed Doppler echocardiography.
- To correlate changes in diastolic filling with the severity of coronary stenosis.
Main Methods:
- Serial pulsed Doppler echocardiography in 50 patients with stable exertional angina.
- Measurement of peak rapid filling velocity and atrial filling ratio pre- and post-PTCA.
- Comparison of diastolic filling changes based on stenosis severity (mild vs. severe).
Main Results:
- Left ventricular diastolic filling improved gradually after PTCA.
- Peak rapid filling velocity increased; atrial filling ratio decreased post-PTCA.
- Greater improvement observed in patients with severe ( >90%) stenosis compared to mild (<=90%).
Conclusions:
- Gradual improvement in diastolic filling post-PTCA suggests recovery from myocardial stunning.
- Pulsed Doppler echocardiography can noninvasively assess coronary stenosis changes.
- Echocardiographic assessment may predict coronary restenosis after PTCA.
Abstract:
To determine the effects of changes in coronary stenosis on left ventricular diastolic filling, diastolic filling was serially examined before and after percutaneous transluminal coronary angioplasty using pulsed Doppler echocardiography in 50 patients with stable exertional angina pectoris. Peak rapid filling velocity and the ratio of peak atrial filling to peak rapid filling velocities were measured from the transmitral flow velocity pattern before and 2 and 9 days after coronary angioplasty. Peak rapid filling velocity increased and the ratio of peak atrial filling to peak rapid filling velocities decreased gradually after coronary angioplasty. The improvement in left ventricular diastolic filling was greater in patients with severe (greater than 90%) coronary stenosis than in patients with mild (less than or equal to 90%) coronary stenosis. In the long-term follow-up period, the improved left ventricular diastolic filling worsened in only 11 patients with marked progression to greater than 90% coronary stenosis. Thus, left ventricular diastolic filling improved gradually after coronary angioplasty, possibly reflecting post-ischemic "stunned" myocardium. Serial examinations of left ventricular diastolic filling with pulsed Doppler echocardiography may be a means of noninvasively assessing the temporal changes in the coronary stenosis and predicting the occurrence of coronary restenosis after coronary angioplasty.