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Relation between diastolic left ventricular function and myocardial blood volume during adenosine-induced coronary
J F Ren1, S B Pancholy, J G Kegel
1Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
Insights
Adenosine infusion increased left ventricular (LV) mass more in healthy individuals than in coronary artery disease (CAD) patients. This change correlated with altered diastolic function, suggesting LV mass changes impact LV performance.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Background:
- Adenosine increases coronary blood flow and myocardial blood volume.
- Myocardial blood volume changes may affect left ventricular (LV) diastolic performance.
- Diastolic dysfunction can result from myocardial ischemia.
Purpose of the Study:
- To investigate the relationship between changes in LV mass during adenosine-induced coronary hyperemia and LV diastolic function.
- To compare these changes in patients with and without coronary artery disease (CAD).
Main Methods:
- Serial two-dimensional and Doppler echocardiography before, during, and after adenosine infusion (140 µg/min for 6 min).
- Measurements in 21 patients with CAD (group 1) and 10 without (group 2).
- Determination of LV mass and transmitral diastolic filling indexes.
Main Results:
- Adenosine infusion increased LV mass significantly more in group 2 (29% ± 11%) than in group 1 (9% ± 6%).
- The early (E) to atrial (A) filling velocity (E/A) ratio increased in group 2 and decreased in group 1.
- A correlation was found between the change in E/A ratio and LV mass (r = 0.53, p < 0.003).
Conclusions:
- Adenosine infusion causes a greater increase in LV mass in normal subjects compared to patients with CAD.
- Doppler-derived indexes of diastolic LV function are altered by adenosine infusion.
- Changes in LV mass during hyperemia are related to diastolic function.
Abstract:
Adenosine infusion is accompanied by increases in coronary blood flow and myocardial blood volume. Myocardial blood volume may produce changes in diastolic left ventricular (LV) performance by increasing myocardial turgor. Diastolic dysfunction may also be the result of myocardial ischemia. The relation between changes in LV mass and diastolic function has not been previously investigated. This study examined the relation between changes in LV mass during adenosine-induced coronary hyperemia and LV diastolic function. Serial two-dimensional and Doppler echocardiographic measurements were made before, during, and after adenosine infusion (140 micrograms/min for 6 min) in 21 patients with (group 1) and 10 patients without (group 2) coronary artery disease (CAD). The LV mass and transmitral diastolic filling indexes were determined from digitized images from apical four-chamber view. Adenosine infusion produced a greater increase in LV mass in group 2 than in group 1 (29% +/- 11% vs 9% +/- 6%, p < 0.0002). The ratio of transmitral early (E) to atrial (A) filling velocity (E/A) increased 10% +/- 16% in group 2 and decreased 8% +/- 20% in group 1 (p < 0.02), and the velocity time integral of early filling increased 11% +/- 52% in group 2 and decreased 20% +/- 31% in group 1 (p < 0.04). There was a correlation between the change in E/A ratio and the LV mass (r = 0.53, p < 0.003). Thus adenosine infusion caused a greater increase in LV mass in normal subjects than in patients with CAD. There were also changes in Doppler-derived indexes of diastolic LV function.(ABSTRACT TRUNCATED AT 250 WORDS)