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[Outcome of Doppler parameters of left ventricular systolic function during atrial stimulation as a function of
C Selton-Suty1, J Anconina, P Buffet
1Service de cardiologie B, CHU Nancy-Brabois, Vandoeuvre-lès-Nancy.
Insights
Transesophageal atrial pacing significantly impacts left ventricular outflow tract Doppler parameters in coronary artery disease patients, unlike in healthy individuals. These findings highlight differences in cardiac response to pacing between healthy and diseased hearts.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Transesophageal atrial pacing is a method to assess cardiac function.
- Doppler echocardiography provides key parameters of left ventricular outflow tract (LVOT) flow.
Purpose of the Study:
- To investigate the effects of transesophageal atrial pacing on LVOT Doppler parameters in patients with and without coronary artery disease (CAD).
Main Methods:
- Eighty-nine patients (8 with normal coronary arteries, 21 with CAD) underwent transesophageal atrial pacing, increasing heart rate from 90 to 130 bpm.
- LVOT Doppler parameters including maximal velocity (V max), velocity-time integral (VTI), mean acceleration (Acc), and acceleration force (AF) were measured.
Main Results:
- In CAD patients, pacing decreased V max and AF, while Acc remained stable. In controls, V max and AF were unchanged, but Acc increased.
- The velocity-time integral (VTI) decreased significantly in both groups.
- Percentage variations in V max, Acc, and AF differed significantly between CAD patients and controls.
Conclusions:
- Transesophageal atrial pacing elicits distinct changes in LVOT Doppler parameters in patients with coronary artery disease compared to healthy individuals.
- These findings suggest impaired myocardial response to increased heart rate in the presence of coronary stenoses.
Abstract:
The authors studied the effects of transoesophageal atrial pacing on Doppler parameters derived from flow in the left ventricular out flow tract (maximal velocity (V max), velocity-time integral (VTI), mean acceleration of aortic flow (Acc), acceleration force (AF) of the left ventricle). These parameters were recorded in patients with normal left ventricular wall motion at rest, with and without coronary disease. Eight patients had angiographically normal coronary arteries (Group 1) and 21 had coronary disease (Group 2) including 10 with an isolated stenosis of the left anterior descending artery (Group 2a) and 11 with multivessel disease (Group 2b). The heart rate was increased by increments of 20 beats per minute from 90 to 130 each minute. In coronary patients, atrial pacing resulted in a fall in V max from 0.99 +/- 0.15 to 0.90 +/- 0.12 m/s, p < 0.0005 and in AF from 23.1 +/- 6.3 to 19.6 +/- 4.8 Kdynes, p < 0.0005, whereas the Acc remained stable (13.51 +/- 3.27 and 13.53 +/- 2.47 m/s/s, NS). Conversely, V max (1.04 +/- 0.11 and 1.04 +/- 0.11, NS) and AF (25.2 +/- 5.7 and 26.3 +/- 6.7, NS) were unchanged in normal controls and the Acc improved from 13.87 +/- 3.61 to 17.04 +/- 3.49, (p < 0.05). The VTI fell significantly in both groups. The percentage variations of V max, Acc and AF were significantly different in coronary patients compared with normal controls. There were no differences between the two coronary subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)