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Variability of changes in Doppler transmitral filling pattern during stress echocardiography in patients with stable
Insights
This study found that in patients with stable angina pectoris, stress echocardiography revealed non-linear changes in transmitral flow and deceleration time, indicating diastolic dysfunction during stress. These findings highlight the importance of assessing diastolic function under stress conditions.
Area of Science:
- Cardiology
- Physiology
Background:
- Stable angina pectoris is often associated with diastolic dysfunction.
- Assessing diastolic function during physiological stress is crucial for understanding cardiac performance.
Purpose of the Study:
- To investigate changes in diastolic function parameters during stress in patients with stable angina pectoris.
- To correlate these changes with pulmonary artery wedge pressure responses.
Main Methods:
- 21 patients with stable angina underwent stress electrocardiography, echocardiography, and right-sided heart catheterization with atrial pacing.
- Transmitral flow (E/A ratio) and deceleration time were measured alongside pulmonary artery wedge pressure at rest and during stress.
Main Results:
- Patients were grouped based on pulmonary artery wedge pressure increase during stress.
- Group A (significant pressure increase) showed non-linear changes in E/A ratio and deceleration time.
- Specifically, E/A ratio decreased and then increased, while deceleration time shortened significantly at peak stress in Group A.
Conclusions:
- Stress-induced changes in transmitral flow and deceleration time reflect altered diastolic function in stable angina.
- These echocardiographic parameters, assessed during stress, can help identify patients with significant hemodynamic responses.
Abstract:
Stress electrocardiography and echocardiography using atrial pacing together with the right-sided heart catheterization were performed in 21 patients with stable angina pectoris. Peak velocity of transmitral flow in early diastole (E) and in atrial contraction (A), deceleration time of early filling, and pulmonary artery wedge pressure were measured simultaneously at rest and immediately after each pacing frequency. Patients were divided according to their stress pulmonary artery wedge pressure changes into Group A (14 patients with an increase in pulmonary artery wedge pressure > or = 3 mmHg during stress) and into Group B (6 patients with a change in pulmonary artery wedge pressure < or = 2 mmHg during stress). One patient, T.L., with an increase in pulmonary artery wedge pressure > or = 5 mmHg after each pacing frequency was evaluated separately. In Group A patients, the non-linear course of the E/A ratio changes (from 0.78 +/- 0.06 to 0.66 +/- 0.05, P < 0.01; to 0.72 +/- 0.05, P = NS; and to 0.93 +/- 0.06, P < 0.01) and deceleration time changes (from 188.9 +/- 7.2 ms to 195.3 +/- 8.9 ms, P = NS; to 188.8 +/- 9.9 ms, P = NS; and to 154.2 +/- 6.7 ms, P < 0.01) was seen.(ABSTRACT TRUNCATED AT 250 WORDS)