[The Doppler echocardiographic assessment of left ventricular diastolic function in coronary heart disease].
OBJECTIVE
Changes in left ventricular (LV) diastolic function lead to characteristic changes in the transmitral flow profile as determined by Doppler echocardiography (DEC). Although DEC cannot provide direct quantitative measurement of LV filling pressures and is influenced by several factors, transmitral flow correlates well with LV haemodynamics. In this prospective study the results of transthoracic DEC were compared with haemodynamic parameters in patients with coronary heart disease (CHD) and their clinical value assessed.


METHODS
254 consecutive patients with CHD (67 women, 187 men, aged 62.5 +/- 8.5 years) underwent transthoracic DEC. The ratio of early to late diastolic velocity (VE/VA) and early diastolic deceleration time (DT) of the transmitral flow were measured as an indication of diastolic LV function.


RESULTS
Patients with reduced LV compliance and increased filling pressure (LV end-diastolic pressure [LVEDP] > 15 mm hg) had a restrictive transmitral flow profile with a significantly higher than normal VE/VA and a shorter DT (1.35 +/- 0.84 vs. 0.86 +/- 0.26, P < 0.001; and 158 +/- 45 vs. 213 +/- 35, P < 0.001, respectively). VE/VA and DT also significantly correlated with LVEDP (r = 0.65, P < 0.001 and r = -0.60, P < 0.001 respectively). Sensitivity and specificity of an LVEDP of > 15 mm Hg were 67% and 84%, respectively, for a VE/VA of more than 1, and 65% and 91% for a DT of less than 170. The combination of the two parameters increased specificity to 97%.


CONCLUSIONS
Determining the transmitral flow profile makes it possible noninvasively to obtain an indication of LV end-diastolic function. Patients with severe diastolic dysfunction and increased filling pressures are recognized with a high degree of specificity.
Weihs
W
W
II. Medizinische Abteilung, Kardiopulmonales Departement, Landeskrankenhaus und Universitätsklinikum Graz.
Anelli-Monti
B
B
Schuchlenz
H
H
Harb
S
S
D000368:Aged; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D016277:Ventricular Function, Left
Dopplerechokardiographische Beurteilung der diastolischen linksventrikulären Funktion bei koronarer Herzkrankheit.