Circulation, Vol 88, 2705-2713, Copyright © 1993 by American Heart Association
M Stugaard, OA Smiseth, C Risoe and H Ihlen
BACKGROUND. Color M-mode Doppler echocardiography has been suggested as a
new noninvasive technique for assessing left ventricular diastolic
function. The present study investigated intraventricular filling pattern
by color M-mode Doppler in patients during percutaneous transluminal
coronary angioplasty (PTCA). In a dog model of myocardial ischemia, the
color M-mode flow pattern was related to indices of global and regional
myocardial function. METHODS AND RESULTS. From color M-mode images, the
time difference (TD) between occurrence of peak velocity in the apical
region and at the mitral tip was determined in 20 patients and eight
anesthetized dogs during coronary occlusions. During PTCA, the timing of
peak velocity was progressively delayed from mitral valve to apex.
Consistent with this, the dog model showed delayed apical filling during
coronary occlusion; TD increased from 18 +/- 4 to 71 +/- 9 milliseconds (P
< .01). In the ischemic region, systolic shortening (sonomicrometry)
decreased from 20 +/- 3% to -5 +/- 2% (p < .01). The one-third filling
fraction decreased from 59 +/- 5% to 31 +/- 6% (P < .01) and correlated
with TD (r = .85, P < .01). The time constant of isovolumic relaxation
(tau) increased slightly and correlated with TD (r = .81, P < .01).
Pacing tachycardia, caval constriction, and volume loading were performed
to mimic the ischemia- induced changes in heart rate, stroke volume, and
intracavitary filling pressure, respectively. There were no significant
changes in TD or tau during these interventions. CONCLUSIONS. Color M-mode
Doppler echocardiography showed a marked delay of apical peak filling
velocity during PTCA. The experimental data suggest that this reflects
retarded filling of the ischemic ventricle. Thus, color M-mode Doppler may
provide a useful method for assessing diastolic dysfunction.
ARTICLES
Intraventricular early diastolic filling during acute myocardial ischemia, assessment by multigated color m-mode Doppler echocardiography
Medical Department B Rikshospitalet University Hospital, Oslo, Norway.
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