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Influence of left ventricular asynchrony on filling in coronary artery disease
P Perrone-Filardi1, S Betocchi, G Giustino
1Institute of Internal Medicine, Cardiology and Cardiac Surgery, University of Naples, Second School of Medicine, Italy.
Insights
Left ventricular (LV) asynchrony significantly impairs LV rapid filling in coronary artery disease (CAD) patients. Higher asynchrony levels correlate with reduced filling rates, particularly in patients with severe LV dysfunction.
Area of Science:
- Cardiology
- Cardiac Physiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) can lead to impaired left ventricular (LV) function.
- LV filling dynamics are crucial for cardiac output and are affected by LV contractility and synchrony.
Purpose of the Study:
- To investigate the relationship between the extent of LV asynchrony and the impairment of LV rapid filling in patients with CAD.
- To determine if LV asynchrony is a significant factor in diastolic dysfunction in CAD.
Main Methods:
- 48 patients with CAD underwent radionuclide angiography and cardiac catheterization.
- Patients were categorized into groups based on LV kinesis (normal/mild hypokinesia vs. dyskinesia/akinesia).
- LV asynchrony was assessed using the time to end-systole coefficient of variation, and LV filling was evaluated by peak filling rate.
Main Results:
- Patients with more severe LV dysfunction (Group II) exhibited significantly higher LV asynchrony and lower peak filling rates compared to Group I.
- A strong inverse correlation was observed between LV asynchrony and peak filling rate in patients with normal to mildly impaired LV function (Group I).
- This correlation persisted even after normalizing for RR interval and expressing peak filling rate in stroke counts.
Conclusions:
- The extent of LV asynchrony plays a significant role in the impairment of LV rapid filling in CAD patients.
- LV asynchrony is a critical determinant of diastolic dysfunction, especially in the presence of significant LV wall motion abnormalities.
- Early assessment and management of LV asynchrony may be important for improving diastolic function in CAD.
Abstract:
To evaluate whether the extent of left ventricular (LV) asynchrony plays a role in the impairment of LV rapid filling in patients with coronary artery disease (CAD), 48 patients underwent both radionuclide angiography and cardiac catheterization. Patients were divided into group I (n = 33), with normal LV kinesis or only mild hypokinesia, and group II (n = 15), with LV dyskinesia or akinesia. Radionuclide ejection fraction was higher in group I than in group II (62 +/- 12 vs 44 +/- 20%; p less than 0.001). Peak filling rate was significantly lower in group II (1.9 +/- 0.8 vs 2.6 +/- 0.9 end-diastolic counts/s; p less than 0.01). Time to end-systole coefficient of variation, an index of the extent of LV asynchrony, was significantly higher in group II than in group I (43 +/- 10 vs 35 +/- 6; p less than 0.0002). In group I, a highly significant inverse relation was found between this index of asynchrony and peak filling rate (r = 0.71; p less than 0.0001). This correlation was found even when time to end-systole coefficient of variation was normalized to the RR interval (r = 0.49; p less than 0.01) and when peak filling rate was expressed in stroke counts (r = 0.57; p less than 0.001). The correlation between peak filling rate and index of asynchrony was maintained up to an end-systole coefficient of variation value of approximately 35. In group II patients (most with an asynchrony value greater than or equal to 35) no relation was found between time to end-systole coefficient of variation and peak filling rate.