Details

Autor(en) / Beteiligte

• Labovitz, Arthur J.
• Lewen, Marc K.
• Kern, Morton
• Vandormael, Michel
• Deligonal, Ubeydullah
• Kennedy, Harold L.

Titel

Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty

Ist Teil von

• Journal of the American College of Cardiology, 1987-10, Vol.10 (4), p.748-755

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

1987

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Acute myocardial ischemia is known to cause impairment of both left ventricular systolic and diastolic function. To further investigate these changes as well as their relation to common clinical variables (electrocardiographic [ECG] changes and chest pain), 32 patients were evaluated with Doppler echocardiography during coronary angioplasty. Doppler indexes of left ventricular diastolic function included the ratios of peak early to late and peak early to mean diastolic velocities as well as the ratios of early to late and first third to total velocity integral (one-third filling fraction). All diastolic indexes showed significant impairment by 15 seconds after coronary occlusion (ratio peak early to late filling velocity: 1.11 versus 0.96, p < 0.01; ratio peak early to mean filling velocity: 1.9 versus 1.7, p < 0.01; ratio early to late velocity integral: 1.58 versus 1.25, p < 0.01; one-third filling fraction: 41.2 versus 37.7, p < 0.01). Left ventricular systolic function was evaluated during coronary occlusion both qualitatively, as assessed by the appearance of a new wall motion abnormality on two-dimensional echocardiography (mean 28.8 seconds), and quantitatively by measurement of systolic percent area change on the two-dimensional short-axis view as well as the Doppler echocardiographic stroke integral index. Systolic indexes did not show significant change until 30 seconds after balloon inflation (percent area change: 42.8 versus 29.2, p < 0.01; stroke integral index: 11.04 versus 9.36, p < 0.01). ECGs were performed at 15 second intervals. New ST segment elevation of 1 mm occurred in 26 of the 32 patients studied, whereas only half of the study patients developed typical anginal chest pain during coronary artery occlusion. In general, the ECG changes preceded the development of chest pain as well as left ventricular systolic dysfunction except in patients with significant collateral circulation. Diastolic left ventricular dysfunction was the earliest change seen after coronary occlusion regardless of the presence of collateral circulation. Systolic and diastolic abnormalities were noted to return to baseline by 15 seconds after balloon deflation. This study confirms that the response to acute transient myocardial ischemia involves both systolic and diastolic dysfunction. In addition, these data suggest that the ischemic response is heralded by left ventricular diastolic impairment followed by ECG changes, systolic impairment and angina, respectively.