Copyright © 1991 by the European Society of Cardiology.
© 1991 The European Society of Cardiology
Effects of coronary angioplasty on left ventricular diastolic filling in patients with old myocardial infarction: A study with pulsed Doppler echocardiography
Cardiovascular Division, Osaka Police Hospital, Osaka University School of Medicine Osaka, Japan
*The First Department of Medicine, Osaka University School of Medicine Osaka, Japan
Received 25 April 1989; revised 30 September 1989; .
Address for correspondence. Tohru Masuyama, M.D., The First Department of Medicine, Osaka University School of Medicine. 1-1-50 Fukushima, Fukushimi-ku, Osaka 553, Japan.
Abstract
To examine the effects of percutaneous transluminal coronary angioplasty (PTCA) on left ventricular diastolic filling in patients with an old myocardial infarction, transmitral flow velocity pattern was measured using pulsed Doppler echo-cardiography before and after PTCA for the peak early diastolic filling velocity ( E ) and the ratio of the early diastolic filling to peak atrialfilling velocities (EIA ratio) in 73 patients with coronary artery disease. These patients were classified into three groups: 34 patients without previous myocardial infarction (no MI group), 16 patients with an old myocardial infarction in whom a non-infarct-related vessel was reperfused by PTCA (MI-1 group), and 23 patients with an old myocardial infarction in whom the infarct-related vessel was reperfused by PCTA (MI-2 group). The degree of improvement in left ventricular diastolic filling was calculated using the values before PTCA as controls. The % increases in Eand EIA ratio were 20 ± 15 and 25 = 19%, respectively, in the no M1 group and 27± 20 and 18 ± 16%, respectively, in the MI-1 group and there was no significant difference between these groups. The % increases in E and E/A ratio in the MI-2 group were 7 ± 19 and 6 ± 17%, respectively, and were significantly (P<0–05) less than those in the no MI and MI-1 groups. An increase in E, E/ A ratio or both by 20% or more was observed in 21 of the 34 (62%) patients of the no MI group, in 10 of the 16 (63%) patients of the MI-1 group and in six of the 23 (26%) patients of the Ml-2 group.
Thus, reperfusion of a non-infarct-related vessel in patients with an old myocardial infarction improves left ventricular diastolic filling to the same degree and with the same frequency as in patients without myocardial infarction. Reperfusion of the infarct-related vessel has less effect on left ventricular diastolic filling, possibly reflecting the smaller amount or less density of viable but ischaemic myocardium to be reperfused. Improvement in left ventricular diastolic filling was observed in about a quarter of patients in whom the infarct-related vessel was reperfused.
Key Words: Myocardial infarction • percutaneous transluminal coronary angioplasty • pulsed Doppler echo-cardiography • transmitral inflow velocity • diastolic function
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