Noninvasive Evaluation of Left Ventricular Diastolic Function in Patients with Ischemic Heart Disease: Reconstruction of Transmitral Flow Rate and Filling Volume Curve with M-Mode, 2-Dimensional and Doppler Echocardiography

ABSTRACT

To evaluate the disturbed left ventricular diastolic filling by pulsed Doppler echocardiography in patients with ischemic heart disease who have normal systolic function, 117 subjects (50 angina patients with, 39 myocardial infarction patients with, 28 control subjects without significant coronary arterial narrowing) underwent echocardiographic examination one day before coronary arteriography. Beside analyzing trasmitral flow velocity curve, reconstruction and quantitative analysis of left ventricular filling rate and filling volume curves were made from Doppler trasmitral flow velocity curve, 2-Dimensional mitral annulus diameter and M-Mode mitral valve motion. From reconstructed left ventricular filling rate, filling fraction during early rapid filling or half diastolic rate, ratio of early to atrial peak filling rate, filling fraction during early rapid filling or half diastolic period and diastolic time interval(esp. T1/2 from peak early filling rate to its half valve)were measured. Angina and myocardial infarction group had significantly lower normalized peak early filling rate(4.9+/-0.6, 4.8+/-1.2 vs 6.0+/-1.1 DFV/sec, P<0.005), ratio of early to atrial peak filling rate(103.6+/-29. 4120.6+/-3.5 VS 175.5+/-55.0%, P<0.005), filling fraction during early diastolic period(46.2+/-5.0, 44.4+/-12.6 VS 54.3+/-6.8%, P<0.005) and filling fraction during half diastolic period(56.3+/-5.8, 55.4+/-14.1 VS 66.6+/-7.7%, P<0.005) than those of control group. Angina and myocardial infarction group had significantly higher normalized peak atrial filling rate(4.9+/-1.4, 5.0+/-2.0 VS 3.5+/-0.9 DFV/sec, P<0.005), prologed normalized T1/2 (12.5+/-3.0, 12.0+/-4.0 VS 9.8+/-2.2%, P<0.005) and delayed isovolumic relaxation time(81.7+/-7.8, 95.0+/-13.6 VS 74.3+/-6.9msec, P<0.005) than those of control group. Affecting factors to pseudonormalize left ventricular filling rate and filling volume curves in myocardial infarction group were mitral regurgitation, left ventricular aneurysm and severe impairment of systolic function. In 13 angina group patients who had undergone coronary angioplasty, no difference were found in any noninvasive diastolic filling parameters before and immediately(24 hours and 5 days) after the procedure. Thus, abnormal patterns of left ventricular filling occur in patients with ischemic heart disease and near normal global systolic function. The decreased peak early filling rate and early filling fraction occuring during rapid filling and the increased peak atrial filling rate occuring in late diastolic suggest that the patients with ischemic heart disease have impaired early diastolic filling. These diastolic filling abnormalities are unimproved 24 hour and 5 days after succesful coronary angioplasty. These diastolic filling parameters from left ventricular filling rate and filling volume curves provide useful noninvastive hemodynamic indices for assessment of left ventricular diastolic filling in patients with ischemic heart disease.