Doppler assessment of left ventricular filling pattern in silent ischemia in patients with Prinzmetal's angina

Elisabetta Doria, Piergiuseppe Agostoni, Alessandro Loaldi, Cesare Fiorentini

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Abstract

Spontaneous angina is an ideal condition in which to study left ventricular (LV) dysfunction induced by acute myocardial ischemia. In 6 patients with Prinzmetal's angina, LV diastolic function during 16 episodes of spontaneous angina was studied by simultaneous recordings of electrocardiographic (ECG), echocardiographic and hemodynamic parameters. In particular, pulsed Doppler echocardiography measured peak velocity of early (E) and late (A) transmitral flow and E A ratio, as indexes of relative early versus late LV filling. During the ischemic attacks, the time sequence of pulsed Doppler echocardiographic and ECG changes showed 3 distinct phases: (1) waxing phase: transmitral flow changes with minimal ECG modifications ( E A = 0.85 ± 0.1); (2) "steady" phase: maximal ECG changes ( E A = 0.9 ± 0.1); and (3) "waning" phase: regression of the ECG changes ( E A = 1.26 ± 0.15). In each phase, E A ratio showed a significant difference from the baseline value ( E A = 1.17 ± 0.2) as a result of changes in E, suggesting that myocardial ischemia affects mainly the early phase of diastole. In the waxing phase, LV diastolic dysfunction preceded systolic abnormalities, as documented by a significant reduction of E A ratio in the absence of alterations in LV ejection fraction, as well as in systemic arterial and pulmonary wedge pressures. Finally, all the recorded parameters were consistent with LV "contractile rebound" occurring in the waning phase and affecting both diastole and systole.

Original languageEnglish
Pages (from-to)1055-1059
Number of pages5
JournalThe American Journal of Cardiology
Volume66
Issue number15
DOIs
Publication statusPublished - Nov 1 1990

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Variant Angina Pectoris
Diastole
Left Ventricular Dysfunction
Myocardial Ischemia
Ischemia
Doppler Pulsed Echocardiography
Pulmonary Wedge Pressure
Systole
Left Ventricular Function
Stroke Volume
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Doppler assessment of left ventricular filling pattern in silent ischemia in patients with Prinzmetal's angina. / Doria, Elisabetta; Agostoni, Piergiuseppe; Loaldi, Alessandro; Fiorentini, Cesare.

In: The American Journal of Cardiology, Vol. 66, No. 15, 01.11.1990, p. 1055-1059.

Research output: Contribution to journalArticle

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