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Left ventricular diastolic performance at rest in patients with angina and normal systolic function--assessment by
Insights
Diastolic dysfunction is common in ischemic heart disease patients with normal systolic function. Its severity correlates with exercise-induced ischemia severity, not prior heart attacks, suggesting PFR reflects early diastolic dysfunction.
Area of Science:
- Cardiology
- Cardiac Physiology
- Diagnostic Imaging
Background:
- Ischemic heart disease (IHD) can affect cardiac function beyond systolic performance.
- Diastolic dysfunction is increasingly recognized as a significant contributor to IHD pathophysiology.
- Assessing diastolic function is crucial for comprehensive patient evaluation.
Purpose of the Study:
- To investigate the relationship between diastolic function parameters and the severity of ischemic heart disease.
- To evaluate diastolic function using peak filling rate (PFR) and time to peak filling rate (TPFR).
- To correlate these diastolic measures with exercise electrocardiography (ECG) findings in patients with IHD.
Main Methods:
- Equilibrium radionuclide angiocardiography (ERNA) was performed on 83 patients with effort angina and normal resting ejection fraction.
- Patients underwent exercise ECG to assess ischemia severity.
- Diastolic function was evaluated by PFR and TPFR.
Main Results:
- Diastolic dysfunction, identified by PFR and TPFR, is prevalent in IHD patients with preserved systolic function.
- The degree of diastolic dysfunction correlated more strongly with ischemia severity on exercise ECG than with a history of myocardial infarction.
- PFR was particularly indicative of early diastolic dysfunction.
Conclusions:
- Diastolic dysfunction is a common finding in ischemic heart disease patients with normal systolic function.
- Exercise ECG-derived ischemia severity is a key determinant of diastolic dysfunction.
- Findings support the hypothesis that PFR reflects early active diastolic dysfunction in IHD.
Abstract:
The aim of the study was to correlate diastolic function, as evaluated by peak filling rate (PFR) and relative time (TPFR), with the severity of ischemic heart disease, as evaluated by exercise electrocardiography. Accordingly, 83 ischemic patients with effort angina, but normal ejection function at rest and normal left ventricular size, were studied by equilibrium radionuclide angiocardiography within two weeks from the exercise ECG. Diastolic dysfunction, as determined from PFR and, to a lesser extent, from TPFR, is common in patients with ischemic heart disease and normal systolic function. The prevalence and severity of such dysfunction is related more to the severity of the ischemia, as evaluated by the exercise ECG, than to the presence of an old myocardial infarction. Such findings are consistent with the hypothesis that PFR reflects mainly the early diastolic active uncoupling process.