Left ventricular diastolic properties and filling characteristics during spontaneous angina pectoris at rest

Diastolic left ventricular (LV) properties were studied at rest and during spontaneous angina pectoris during cardiac catheterization in 10 patients with severe coronary artery disease. During spontaneous angina there was a significant increase in LV filling pressures through diastole. The right ventricular end-diastolic pressure was measured at rest and during spontaneous angina in 7 of 10 patients and showed an increase from 7 +/- 3 to 10 +/- 4 mm Hg (mean +/- SD) (p less than 0.02). The T index (a measure of LV isovolumic relaxation) at rest was 51 +/- 17 ms and increased during angina to 58 +/- 12 ms (p less than 0.01), indicating an early diastolic relaxation dysfunction. Frame-by-frame LV volumes and corresponding pressures were analyzed from 3 consecutive beats in 5 of 10 patients. In 4 of these 5, the pressure-volume loop shifted upward and slightly to the right during angina. There was a significant increase in the rate of filling during mid-diastole with angina. Left atrial stroke work index increased by 35% during angina, suggesting an increased work load on the left atrium to maintain late diastolic filling.