[Transmitral blood flow velocity patterns evaluated by pulsed Doppler echocardiography in diagnosing transient...

To evaluate the influences of transient myocardial ischemia on transmitral blood flow velocity patterns, pulsed Doppler echocardiography was performed during coronary artery occlusion in 10 anesthetized open-chest dogs, and also during esophageal pacing or the administration of dipyridamole in 79 patients with coronary artery disease (CAD), and in 19 control subjects. During occlusion of the coronary artery, an abrupt decrease in the peak velocity of the rapid filling wave (R) was noted within one min simultaneously with rapid decrease of % wall thickening in the ischemic regions. The peak velocity of atrial filling was augmented compensatorily. Although the transmitral blood flow velocity pattern did not change in the controls with esophageal pacing, changes similar to those which were obtained during experimental studies were demonstrated in CAD patients. There were no significant differences between transmitral blood flow velocity patterns of patients with multivessel disease and those with single vessel disease. Ischemic changes in transmitral blood flow velocity patterns were not demonstrated in patients with mitral regurgitation. Sublingual nitroglycerin normalized post-pacing abnormal blood flow velocity patterns. In contrast, after the intravenous administration of 0.56 mg/kg of dipyridamole, R and A were increased and the A/R ratio was unchanged both in CAD patients and the control groups. Deceleration time, or the half time, was prolonged during both provocation tests in CAD patients, and these changes were transient and were restored within several min. Furthermore, they were noted more frequently than was the development of ST depression on ECG, or chest pain. These findings indicate that the transmitral blood flow velocity patterns obtained by pulsed Doppler echocardiography are useful for detecting transient myocardial ischemia, though they have limitations in diagnosing the extent of coronary artery disease.