Doppler echocardiographic assessment of left ventricular filling dynamics in patients with coronary heart disease and
H F Kuecherer1, K Ruffmann, E Schaefer
1Abteilung Innere Medizin III (Kardiologie), University of Heidelberg, F.R.G.
European Heart Journal
|June 1, 1988
Summary
Coronary artery disease impairs left ventricular diastolic filling during exercise, even with normal systolic function. Pulsed Doppler echocardiography noninvasively detects these exercise-induced diastolic changes in patients with coronary artery disease.
Area of Science:
- Cardiology
- Noninvasive Cardiovascular Imaging
- Diastology
Background:
- Coronary artery disease (CAD) can affect left ventricular (LV) function beyond systolic performance.
- Assessing diastolic filling dynamics noninvasively is crucial for understanding LV mechanics in CAD.
- Normal systolic pump function does not exclude diastolic dysfunction in CAD patients.
Purpose of the Study:
- To evaluate alterations in left ventricular diastolic filling in patients with coronary artery disease using noninvasive methods.
- To compare diastolic filling patterns at rest and during exercise between normal subjects and CAD patients.
- To determine the utility of pulsed Doppler echocardiography in assessing exercise-induced diastolic changes in CAD.
Main Methods:
- Pulsed Doppler echocardiography measured mitral inflow velocity.
- Cross-sectional echocardiography obtained left ventricular volumes at rest and during exercise.
- Peak and integrated early (E) and late (L) diastolic filling velocities were calculated.
- Studies included normal subjects (n=8) and CAD patients (n=18) with normal ejection fraction.
Main Results:
- Ejection fraction did not differ significantly between groups at rest and did not increase with exercise in CAD patients.
- At rest, the early to late diastolic filling velocity integral ratio (E/L) was significantly lower in CAD patients (1.19) compared to normal subjects (1.74).
- During exercise, early diastolic filling decreased in CAD patients, evidenced by a 34% reduction in the E/L index, while it remained unchanged in normal subjects.
Conclusions:
- Pulsed Doppler echocardiography effectively assesses noninvasively exercise-induced changes in LV diastolic filling dynamics.
- Diastolic filling is significantly altered during exercise in patients with coronary artery disease, even with preserved systolic function.
- Noninvasive assessment of diastolic function is vital for comprehensive evaluation of CAD patients.
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