Left atrial and left ventricular diastolic function during acute myocardial ischaemia.
OBJECTIVE
To study indices of diastolic left ventricular function during the first few seconds of myocardial ischaemia.


METHODS
Isovolumic and total relaxation times and left atrial and left ventricular dP/dt were identified from high fidelity (micromanometer) pressure recordings in the left ventricle and left atrium during percutaneous transluminal angioplasty of the left anterior descending coronary artery.


METHODS
20 patients with isolated disease of the left anterior descending artery and normal left ventricular function.


RESULTS
The isovolumic relaxation time lengthened during the first seven to nine seconds of ischaemia; then it shortened by an average of 15% up to the twentieth second, initially as a result of increased left atrial contractility and subsequently because of impaired ventricular relaxation. Ventricular ischaemia resulted in impaired left ventricular diastolic compliance, as shown by an increase in the total relaxation time, before there was evidence of systolic impairment. Minimum dP/dt decreased progressively (by -37% at the twentieth second of ischaemia), whereas maximum dP/dt fell only after 20 seconds of ischaemia (by -11%).


CONCLUSIONS
Relaxation and filling of the left ventricle (indices of diastolic function) are more sensitive to myocardial ischaemia than myocardial contractility and systolic function. Left atrial contractility increases during left ventricular ischaemia.
Stewart
J T
JT
Department of Invasive Cardiology, Royal Brompton National Heart and Lung Hospital, London.
Grbic
M
M
Sigwart
U
U
D000328:Adult; D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000503:physiopathology*; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*