Dynamics of early and late left ventricular filling determined by Doppler two-dimensional echocardiography during percutaneous transluminal coronary angioplasty.
To study the influence of ischemia on both early and late left ventricular filling, Doppler 2-dimensional echocardiography was used to measure filling parameters during percutaneous transluminal coronary angioplasty (PTCA) in 26 patients. Doppler recordings were taken immediately before balloon inflation and continuously during balloon inflation and deflation until 60 seconds into the recovery period. During PTCA of the left anterior descending artery (16 patients) there was a 35% decrease in early peak filling rate from 269 +/- 88 to 169 +/- 55 ml/s (p less than 0.0005) by 60 seconds of balloon inflation. In patients undergoing PTCA of the left circumflex (4 patients) or dominant right coronary artery (6 patients), the early peak filling rate decreased 15% from 325 +/- 126 to 284 +/- 137 ml/s (p less than 0.005). The decrease in early peak filling rate became evident at approximately 15 seconds after balloon inflation and fully recovered 20 seconds after balloon deflation. Rather than an expected increase in atrial stroke volume and a decrease in early to late filling ratio during coronary occlusion, there was a 28% decrease in atrial stroke volume during left anterior descending coronary artery PTCA and a 6% decrease during right coronary and circumflex PTCA. Because of the simultaneous decrease in both early and late ventricular filling, peak early to late filling ratio was only slightly altered during PTCA. There was an 83% increase in mean pulmonary artery wedge pressure during balloon inflation from 12 +/- 5 to 20 +/- 4 mm Hg. In 11 of these patients global systolic function was measured on subsequent inflations during PTCA using 2-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
Bowman
L K
LK
Department of Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut 06510.
Cleman
M W
MW
Cabin
H S
HS
Zaret
B L
BL
Jaffe
C C
CC
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D001794:Blood Pressure; D003326:Coronary Circulation; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D013599:Systole