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Left ventricular diastolic filling in patients with left ventricular dysfunction
Insights
Abnormal left ventricular diastolic filling patterns are common in patients with severe heart dysfunction from coronary disease or cardiomyopathy. These patterns, characterized by increased peak filling rate to peak ejection rate ratios and stroke volume filling, may relate to elevated pulmonary capillary pressure.
Area of Science:
- Cardiology
- Cardiac Imaging
- Heart Failure Research
Background:
- Left ventricular diastolic dysfunction is crucial in heart failure.
- The specific patterns in coronary artery disease (CAD) with severe dysfunction are not well understood.
- Gated blood pool scans offer insights into cardiac filling dynamics.
Purpose of the Study:
- To investigate the left ventricular diastolic filling patterns in patients with severe left ventricular dysfunction.
- To compare these patterns between coronary artery disease and congestive cardiomyopathy.
- To assess the specificity of these patterns and their relation to pulmonary capillary pressure.
Main Methods:
- Utilized gated blood pool scans to derive left ventricular diastolic filling curves.
- Analyzed parameters including peak filling rate (PFR), peak ejection rate (PER), PFR/PER ratio, % stroke volume at 1/3 diastole (%SV-1/3 DT), and % stroke volume at rapid filling (%SV-RFP).
- Compared data from 21 normal subjects, 61 CAD patients (ejection fraction ≤30%), and 51 congestive cardiomyopathy patients (ejection fraction ≤30%).
Main Results:
- Both CAD and congestive cardiomyopathy groups showed reduced PFR and PER.
- The PFR/PER ratio was significantly increased in both patient groups compared to normals (CAD: 1.19±0.28, Cardiomyopathy: 1.21±0.32 vs. Normal: 0.93±0.20).
- Both patient groups exhibited higher %SV-1/3 DT and %SV-RFP, with further increases noted in patients with elevated mean pulmonary capillary pressure (≥18 mm Hg).
Conclusions:
- An abnormal, non-specific left ventricular diastolic filling pattern exists in severe CAD and congestive cardiomyopathy.
- This pattern is defined by an elevated PFR/PER, increased %SV-1/3 DT, and augmented %SV-RFP.
- Elevated pulmonary capillary pressure may contribute to these observed diastolic filling abnormalities.
Abstract:
The pattern of abnormal left ventricular diastolic filling and its specificity in coronary disease patients with severe left ventricular dysfunction has received little attention. We evaluated the left ventricular diastolic filling curve derived from gated blood pool scans in 21 normals, 61 coronary disease patients with ejection fractions less than or equal to 30%, and 51 congestive cardiomyopathy patients with ejection fraction less than or equal to 30%. The peak filling rate (PFR), peak ejection rate (PER), PFR/PER and the % stroke volume filled at 1/3 of diastole (%SV-1/3 DT) and at the end of the rapid filling period (%SV-RFP) were determined for each group. The PFR and PER were reduced in both coronary disease and congestive cardiomyopathy groups. The PFR/PER was increased in the coronary disease group (1.19 +/- 0.28) and congestive cardiomyopathy group (1.21 +/- 0.32) as compared to normals (0.93 +/- 0.20, P less than 0.001). A greater %SV-1/3 DT and %SV-RFP were noted in both coronary disease and congestive cardiomyopathy groups. Coronary disease and congestive cardiomyopathy patients with a mean pulmonary capillary pressure (PCP) greater than or equal to 18 mm Hg had a greater PFR/PER, %SV-1/3 DT, and %SV-RFP than patients with a PCP less than 18 mm Hg. An abnormal and nonspecific pattern of left ventricular diastolic filling is present in both coronary disease and congestive cardiomyopathy patients and is characterized by an increased PFR/PER, a greater %SV-1/3 DT, and a greater %SV-RFP. This pattern may be related to elevated PCPs.