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Echocardiographic versus hemodynamic monitoring during attacks of variant angina pectoris
Insights
Echocardiography detects early changes in left ventricular (LV) mechanics during variant angina attacks, preceding electrocardiogram (ECG) changes. This imaging technique provides sensitive, regional insights into cardiac function alongside traditional hemodynamic monitoring.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Variant angina, characterized by coronary artery spasm, presents diagnostic challenges.
- Understanding the temporal relationship between mechanical dysfunction and ECG changes is crucial for timely intervention.
- Current hemodynamic monitoring may lack sensitivity for early regional myocardial impairment.
Purpose of the Study:
- To investigate the early detection of left ventricular (LV) mechanical dysfunction during variant angina attacks using combined echocardiography and hemodynamic monitoring.
- To compare the sensitivity and timing of echocardiographic findings with electrocardiographic (ECG) and hemodynamic changes.
- To assess the utility of echocardiography in evaluating regional LV function during ischemic episodes.
Main Methods:
- Six patients experiencing variant angina (n=6) underwent combined echocardiographic and hemodynamic monitoring during ergonovine-induced and spontaneous attacks.
- Key echocardiographic parameters included percent systolic thickening of the ischemic wall and LV end-diastolic diameter.
- Hemodynamic parameters monitored included peak dP/dt of contraction and LV end-diastolic pressure.
Main Results:
- Echocardiography detected reduced systolic thickening in the ischemic wall during the pre-electrocardiographic phase, preceding ST-segment elevation.
- During the electrocardiographic phase (ST elevation), regional function (systolic thickening) reached its nadir, while global function (dP/dt) recovered.
- LV end-diastolic diameter and pressure increased significantly during ST elevation, with supernormal function and reduced dimensions during recovery.
Conclusions:
- Echocardiographic signs of impaired LV mechanics are as early and sensitive as hemodynamic indexes in variant angina.
- Echocardiography provides crucial information on regional LV function and morphology, complementing hemodynamic data.
- Combined echocardiography and hemodynamic monitoring offer a comprehensive assessment of cardiac function during variant angina.
Abstract:
Six attacks of variant angina (2 spontaneous, 4 induced by ergonovine) were studied in 6 patients by combined echocardiographic and hemodynamic monitoring. A decrease of percent systolic thickening of the ischemic wall, which occurred as early as the decrease in peak dP/dt of contraction, was detected before the onset of ST-segment elevation ("pre-electrocardiographic phase"). At this stage, no significant change in left ventricular (LV) end-diastolic pressure or end-diastolic diameter was observed. Subsequently, in the presence of clear-cut ST-segment elevation ("electrocardiographic phase"), percent systolic thickening (an index of regional function) reached its nadir, while dP/dt of contraction (an index of global function) was almost back to preischemic values. In this phase, a significant increase in LV end-diastolic diameter and end-diastolic pressure could be also detected. In the recovery phase, when the ST segment had returned to the isoelectric line ("post-electrocardiographic phase"), percent systolic thickening and dP/dt of contraction showed supernormal values, while LV end-diastolic pressure and end-diastolic diameter decreased below basal values. Thus, echocardiographic signs of impairment in LV mechanics are as early and sensitive as hemodynamic indexes during attacks of variant angina. Furthermore, information on morphologic characteristics and regional LV function, not available with hemodynamic monitoring, can be obtained by echocardiography.