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Left ventricular diastolic performance at rest and during exercise in patients with coronary artery disease.
Insights
First-pass radionuclide angiocardiography reveals early diastolic dysfunction in coronary artery disease patients, even with normal systolic function. Exercise exacerbates this diastolic dysfunction, indicating potential ischemia.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Left ventricular diastolic function is crucial for cardiac health.
- Assessing diastolic performance noninvasively, especially during exercise, remains a challenge.
Purpose of the Study:
- To evaluate left ventricular diastolic performance at rest and during exercise using first-pass radionuclide angiocardiography.
- To identify early diastolic abnormalities in patients with coronary artery disease (CAD).
Main Methods:
- Utilized first-pass radionuclide angiocardiography in 32 normal subjects and 68 CAD patients.
- Measured filling fraction, peak filling rate, and peak filling rate during the first third of diastole.
- Assessed diastolic parameters at rest and during upright bicycle exercise.
Main Results:
- CAD patients exhibited impaired early diastolic filling at rest compared to normal subjects, despite normal ejection fraction.
- Normal subjects showed no change in filling fraction with exercise.
- CAD patients demonstrated a decrease in filling fraction with exercise, indicating worsening diastolic dysfunction.
Conclusions:
- First-pass radionuclide angiocardiography is effective for noninvasive assessment of diastolic function at rest and during exercise.
- Early diastolic dysfunction is common in CAD patients, even with preserved systolic function.
- Exercise-induced ischemia likely contributes to increased early diastolic dysfunction in CAD.
Abstract:
We used first-pass radionuclide angiocardiography to assess filling fraction during the first third of diastole, peak filling rate and peak filling rate during the first third of diastole as indexes of left ventricular diastolic performance at rest and after upright bicycle exercise in 32 normal patients and 68 patients with coronary artery disease. The mean filling fraction was unchanged from rest to exercise in normal patients (47+/- 15% vs 46 +/- 13%; NS). Even in 49 coronary patients with normal (greater than or equal to 50%) ejection fraction at rest, filling fraction was less than that in normal patients at rest (35 +/- 11% vs 47 +/- 15%, p less than 0.001). Despite similar resting heart rates, patients with coronary disease had lower (p less than 0.001) peak filling rate and peak filling rate during the first third of diastole than normal patients. With exercise, filling fraction decreased (p less than 0.001) from the resting value in coronary patients. These data suggest that (1) indexes of diastolic performance can be noninvasively assessed at rest and during exercise using first-pass radionuclide angiocardiography, (2) abnormalities in early diastolic performance are often present at rest in patients with coronary artery disease despite normal systolic performance, and (3) exercise-induced ischemia results in increased early diastolic dysfunction in patients with coronary disease.