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Analysis of left atrioventricular plane movement during diastole in ischemic heart disease
A Kranidis1, K Kostopoulos, G Filippatos
1First Department of Cardiology, Evangelismos Hospital, Athens, Greece.
Insights
Diastolic left atrioventricular plane displacement (AVPD) is reduced in coronary artery disease (CAD) patients, particularly those with left ventricular systolic dysfunction. The atrial contribution to ventricular filling increases in CAD patients, impacting diastolic function assessment.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Coronary artery disease (CAD) can significantly impact left ventricular diastolic function.
- Assessing diastolic function is crucial for understanding cardiac health in CAD patients.
- Left atrioventricular plane displacement (AVPD) is a sensitive echocardiographic marker of diastolic function.
Purpose of the Study:
- To investigate the properties of diastolic left atrioventricular plane displacement (AVPD) in patients with coronary artery disease (CAD).
- To correlate AVPD parameters with left ventricular systolic function and filling behavior in CAD.
- To compare AVPD in CAD patients with and without left ventricular segmental wall motion abnormalities (SWMA).
Main Methods:
- A complete transthoracic echocardiographic study was performed in 125 CAD patients and 51 healthy controls.
- Diastolic left atrioventricular plane displacement (AVPD) was recorded using M-mode echocardiography.
- Mean early diastolic AVPD (E-AVPD), atrial systolic AVPD (A-AVPD), and the A-AVPD/E-AVPD ratio were determined.
Main Results:
- Mean E-AVPD was significantly lower in CAD patients compared to controls (p < 0.001).
- A-AVPD was higher in CAD patients without SWMA versus controls (p = 0.02), and the A-AVPD/E-AVPD ratio was higher in all CAD patients (p < 0.001).
- In CAD patients with SWMA, E-AVPD and A-AVPD correlated positively with left ventricular systolic function indices.
Conclusions:
- Diastolic AVPD parameters are altered in CAD patients, reflecting impaired diastolic function.
- The atrial contribution to left ventricular longitudinal distension is increased in CAD.
- The E-AVPD/A-AVPD ratio correlates well with left ventricular filling behavior, especially in CAD patients without SWMA.
Abstract:
The aim of the present study was to investigate the properties of diastolic left atrioventricular plane displacement (AVPD) in coronary artery disease (CAD) patients. In 125 patients (mean age 58.7 +/- 13.7) with CAD and in 51 age-matched healthy subjects, a complete transthoracic echocardiographic study was performed. The AVPD was recorded by M-mode echocardiography, from apical four and two chamber views at four sites corresponding to the septal, lateral, anterior and inferior walls of the left ventricle. Mean AVPD in early diastole (E-AVPD), mean AVPD from atrial systole (A-AVPD) and the ratio A-AVPD/E-AVPD were determined. In normal subjects, such as in 35 patients without left ventricular segmental wall motion abnormalities (SWMA), stepwise multiple regression analysis showed none of these factors to be significantly related to E-AVPD or A-AVPD. Aging was correlated negatively to the E-AVPD/A-AVPD ratio (p < 0.05). In 90 patients with left ventricular SWMA, stepwise multiple regression analysis showed that indices of left ventricular systolic function correlated positively to E-AVPD (p < 0.001) and A-AVPD (p < 0.001). The E-AVPD/A-AVPD ratio was correlated to left ventricular ejection fraction and heart rate (p < 0.005). Mean E-AVPD was significantly lower in CAD patients than in normal subjects (p 0.001), while A-AVPD was higher in patients without left ventricular SWMA in comparison to normal subjects (p = 0.02). Also, mean A-AVPD/E-AVPD was higher in CAD patients than in the control group (p < 0.001). Mean E-AVPD/A-AVPD was correlated to the E/A ratio of transmitral flow in CAD patients with (r = 0.669) and without (r = 0.771) SWMA. The E-AVPD and A-AVPD in CAD patients with SWMA is reduced according to the deterioration of left ventricular systolic function. The atrial contribution to the longitudinal distension of the left ventricle is increased in CAD patients. In CAD patients, especially those without left ventricular SWMA, the E-AVPD/A-AVPD ratio has a good correlation to left ventricular filling behavior.