Effect of loading conditions on Doppler-derived transmitral flow indices in normal subjects and patients with coronary artery disease.
The influence of alterations in preload and afterload on left ventricular diastolic filling using echocardiography was examined in nine normal volunteers (NLS) and nine patients (PTS) with coronary artery disease. The sequential interventions used were handgrip to increase afterload, nitroglycerin to decrease preload, and nifedipine to decrease afterload. Transmitral flow was measured using pulsed-Doppler echocardiography. Measurements were made pre- and post interventions.  With increase in afterload using handgrip, the A and E wave velocities and the A/E ratio increased in both groups:  0.62 +/- 0.14 versus 0.86 +/- 0.17 in NLS; 0.75 +/- 0.45 versus 0.84 +/- 0.50 in PTS (P less than 0.05). Following administration of nitroglycerin to reduce preload, the A wave velocities increased, the E wave velocity decreased in both groups, and the A/E ratio increased 0.57 +/- 0.11 versus 0.67 +/- 0.13 in NLS; 0.78 +/- 0.40 versus 0.91 +/- 0.44 in PTS (P less than 0.05).  Following use of nifedipine, the A and E wave velocities decreased in both groups with an increase in the A/E ratio in the patient group 0.83 +/- 0.13 versus 0.89 +/- 0.11 (P = NS).  Thus, both normal subjects and patients with coronary artery disease had similar changes in Doppler-derived indices of left ventricular filling following interventions that changed left ventricular preload and afterload.
Department of Medicine, LAC + USC Medical Center, University of Southern California School of Medicine, Los Angeles 90033.
T
T
Tak
R S
RS
Choudhary
S
S
Chatterjee
J
J
Widerhorn
S H
SH
Rahimtoola
P A
PA
Chandraratna
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology; D009543:Nifedipine / Q000494:pharmacology; D005996:Nitroglycerin / Q000494:pharmacology; D016277:Ventricular Function, Left / Q000187:drug effects