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[Diastolic flow analysis of the left ventricle after myocardial infarct]
1II. Med. Klinik und Poliklinik, Johannes-Gutenberg-Universität, Mainz.
Insights
Left ventricular diastolic function, assessed by early diastolic inflow (Vmax E) to atrial contraction (Vmax A) ratio and diastolic delay, is impaired in patients with myocardial infarction. Diastolic delay correlates with wall motion abnormalities.
Area of Science:
- Cardiology
- Echocardiography
- Physiology
Background:
- Diastolic dysfunction is a key indicator of left ventricular (LV) health.
- Assessing LV diastolic function is crucial for diagnosing and managing various cardiac conditions.
Purpose of the Study:
- To investigate left ventricular diastolic function in different subject groups using pulsed wave Doppler.
- To evaluate the E/A ratio and diastolic delay as markers of diastolic function.
- To compare these Doppler-derived parameters with treadmill exercise testing for myocardial ischemia.
Main Methods:
- Pulsed wave Doppler was used to assess diastolic function at eight LV locations.
- Measured parameters included the early diastolic inflow (Vmax E) to maximal atrial contraction velocity (Vmax A) ratio (E/A ratio).
- Measured diastolic delay from electrical diastole end to the A-wave peak.
Main Results:
- The E/A ratio was significantly lower in older volunteers and patients with myocardial infarction compared to young normal volunteers (p=0.020).
- Diastolic delay was significantly prolonged in older volunteers and patients with myocardial infarction, particularly anterior wall infarction (p=0.000).
- Diastolic delay correlated with pathological wall motion segments (r=0.61, p=0.007).
Conclusions:
- Pulsed wave Doppler parameters, especially diastolic delay, effectively detect impaired left ventricular diastolic function.
- Diastolic dysfunction is evident in patients post-myocardial infarction and correlates with regional wall motion abnormalities.
- Significant diastolic delay may be associated with an increased risk of intraventricular thrombus formation.
Abstract:
The diastolic function of the left ventricle was investigated in 12 normal young volunteers, 10 older volunteers, 10 patients without evidence of coronary artery disease, 26 patients with inferior wall and 19 patients with anterior wall infarction at eight locations of the total circumference of the left ventricle using pulsed wave Doppler. The ratio of early diastolic inflow (Vmax E) to the maximal velocity of atrial contraction (Vmax A) was determined. Furthermore, the delay between the end of electrical diastole until the end of the A-wave of the pulsed Doppler was measured. The results were compared with a clinically used marker of myocardial ischemia, treadmill exercise testing. The E/A ratio was 2.03 +/- 0.51 in normal volunteers, 1.16 +/- 0.41 in older volunteers, 1.41 +/- 0.59 in patients without evidence for coronary artery disease, 1.28 +/- 1.13 in patients with inferior and 1.08 +/- 0.41 in patients with anterior wall infarction (p = 0.020 ANOVA). The diastolic delay at the apex was 47.3 +/- 8.9 ms in normal volunteers, 78.3 +/- 8.3 ms in older volunteers, 79.1 +/- 13.7 ms in patients without coronary artery disease, 109.1 +/- 12 ms in patients with inferior and 169.5 +/- 18.8 ms in patients with anterior wall infarction (p = 0.000 ANOVA). There was a correlation between the latter parameter of delay and the amount of pathological wall segments at wall motion analysis (r = 0.61, p = 0.007). In two patients with anterior myocardial infarction (11%) with significant diastolic delay intraventricular thrombi developed consecutively.(ABSTRACT TRUNCATED AT 250 WORDS)