Systolic and diastolic alterations of left ventricular function: prevalence in ischaemic heart disease and importance in the management of individual patients.
Myocardial perfusion and contractile performance are strictly interrelated. Conclusive experimental data show that changes in perfusion cause immediate changes in function, and conversely, that changes in contraction affect both total and regional myocardial blood flow. In ischaemic heart disease, both transient and permanent changes in global and/or regional left ventricular (LV) function have been described. In myocardial ischaemia, an impairment of LV relaxation, as indicated by a reduction of negative dP/dt, is the first appreciable haemodynamic event. When ischaemia is sustained, impairment of LV contraction follows, as indicated by a drop of positive dP/dt, reduction of systolic LV pressure, rise of end-diastolic LV pressure. Unrestricted reperfusion, as in experimental coronary occlusion and in Prinz-Metal angina, is associated with a transient rebound in regional systolic function. Spontaneous and/or induced changes of regional ventricular function provide relevant information for the management of the individual patient. In PTCA candidates monitoring regional contractile performance by mono and two-dimensional echocardiography during dypiridamole infusion has proven to be a sensitive and specific test for (1) assessing the haemodynamic significance of a coronary stenosis in patients with single-vessel disease, (2) identifying the 'culprit' lesion in patients with multiple-vessel disease. During PTCA, right and left ventricular function assessed by radionuclide angiography both at rest and during atrial pacing appears to be a sensitive method for the immediate evaluation of the efficacy of the procedure.
Marzilli
M
M
Institute of Clinical Physiology, Pisa, Italy.
D000800:Angioplasty, Balloon; D003327:Coronary Disease / Q000503:physiopathology* / Q000628:therapy; D003971:Diastole; D004452:Echocardiography; D006321:Heart / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D009200:Myocardial Contraction; D013599:Systole