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European Heart Journal 1994 15(4):462-467;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Influence of left ventricular filling proffle during preceding control beats on pulse pressure during ventricular premature contractions

Y. OTSUJI*, H. TODA{dagger}, A. KISANUKI*, T. KOYANO{dagger}, R. KUROIWA*, T. MURAYAMA*, R. MATSUSHITA*, S. NAKAO*, T. TOMARI{ddagger} and H. TANAKA*,

*First Department of Internal Medicine, Faculty of Medicine, Kagoshima University Kagoshima, Japan
{dagger}Department of Public Health, Faculty of Medicine, Kagoshima University Kagoshima, Japan
{ddagger}Section of Cardiology Kagoshima Municipal Hospital, Japan

Received 21 June 1993; revised 24 November 1993; .

Correspondence: Hiromitsu Tanaka, MD. The First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1 Kagoshima City, 890, Japan

Abstract

We investigated whether the left ventricular filling profile, defined as the early to late diastolic left ventricular filling volume ratio, during the preceding control beats actually affects the pulse pressure during a ventricular premature contraction (PVC). Twenty patients underwent invasive electrophysiological study for sinus bradycardia. VPCs with various coupling intervals were induced by right ventricular electrical stimulation, and the mitral filling flow velocity pulsed Doppler echocardiography, the femoral arterial pressure curve and the electrocardiogram were simultaneously recorded The early to late diastolic velocity-rime integral ratio (E1/A1 ratio) of the mitral filling flow velocity during the control beats which preceded the VPC was measured as an index characterizing left ventricular filling profile. The coupling interval of each VPC and the extrasystolic beat pulse pressure were measured The ratio of the extrasystolic beat pulse pressure to the control beat pulse pressure was expressed in % (% extrasystolic beat pulse pressure). The correlation between the coupling interval and the % extrasystolic beat pulse pressure was investigated. Coupling intervals of 0·80, 0·70, 0·60, 0·50, and 0·45 s were used At a coupling interval of 0·80 or 0·45 s, the % extrasystolic beat pulse pressure showed no significant correlation with the E1/A1 ratio. In contrast, the % extrasystolic beat pulse pressure with coupling intervals of 0·70, 0·60, and 0·50 s showed a significant positive correlation with the E1/A1 ratio (r=0·67, 0·74, and 0·66 P<0·01, respectively). In addition to the prematurity and the site of origin of the VPCs, the left ventricular filling profile during the preceding control beats may significantly affect the height of the pulse pressure during extrasystoles with medium length coupling intervals.

Key Words: Doppler echocardiography • ventricular premature contraction


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