Circulation, Vol 71, 297-307, Copyright © 1985 by American Heart Association
RO Bonow, DF Vitale, SL Bacharach, TM Frederick, KM Kent and MV Green
Left ventricular diastolic filling is impaired in many patients with
coronary artery disease and normal left ventricular systolic function, and
is improved in many patients after coronary angioplasty (PTCA). To
investigate the mechanisms for this improvement, we studied regional
asynchrony by radionuclide angiography in 26 patients with single- vessel
coronary artery disease before and after successful PTCA. Before PTCA, all
patients had normal ejection fractions at rest and normal qualitative left
ventricular regional wall motion, as determined by radionuclide and
contrast angiography. Quantitative left ventricular regional function was
assessed by dividing the left ventricular region of interest into 20
sectors. Phase analysis was performed on each sector's time-activity curve,
and the average intersector phase difference was used as an index of left
ventricular regional synchrony. Before PTCA, average intersector phase
difference was increased compared with normal (6.0 +/- 2.2 vs 4.0 +/- 1.7
degrees, p less than .005), indicating asynchronous regional function.
After PTCA, ejection fraction at rest was unchanged, but peak left
ventricular filling rate at rest increased from 2.5 +/- 0.6 to 3.0 +/- 0.6
end-diastolic volume/sec (p less than .001) and was associated with a
decrease in average intersector phase difference from 6.0 +/- 2.2 to 5.1
+/- 2.3 degrees (p less than .05). Average intersector phase difference
decreased in 16 of 21 patients in whom peak filling rate increased after
PTCA (p less than .005), compared with one of five patients in whom peak
filling rate was unchanged or decreased. Hence, improved global left
ventricular filling after PTCA was associated with more synchronous left
ventricular regional behavior. To identify the cause of regional asynchrony
before PTCA, we then generated time-activity curves from each of four left
ventricular quadrants. These data indicated that the asynchrony was caused
by regional variation in timing of diastolic rather than systolic events
and that PTCA resulted in reduction in regional diastolic asynchrony. These
data suggest that in many patients with coronary artery disease and normal
left ventricular systolic function, impaired global diastolic filling may
result from asynchronous left ventricular regional diastolic function,
which is a reversible manifestation of myocardial ischemia or reduced
coronary flow.
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Asynchronous left ventricular regional function and impaired global diastolic filling in patients with coronary artery disease: reversal after coronary angioplasty
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