Impaired relationship between Doppler echocardiographic parameters of diastolic function and left ventricular filling pressure during acute ischemia

Abstract

The relationship between left ventricular filling pressure and Doppler echocardiographic parameters of diastolic mitral flow (MF) was evaluated in patients with ischemic heart disease during acute ischemia induced by percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending artery. Thirty-two patients were examined by simultaneous recordings of the Doppler MF signal and the mean pulmonary capillary wedge pressure (PCm) as an approximation of left ventricular filling pressure. At rest PCm was correlated with the early/late velocity integral ratio (Ei/Ai: r = 0.62: p < 0.0001 n = 32). In 25 of 32 patients the recordings during PTCA could be evaluated. At the end of the inflation (duration: 69 ± 24 seconds) PCm increased from 11.2 ± 5.5 to 17.2 ± 7.2 mm Hg ( p < 0.001), and total MF integral as an index of systolic ventricular function decreased by 14.9 ± 12.8% ( p < 0.001). Inasmuch as both early and late velocity integrals were reduced during PTCA, the Ei/Ai ratio did not change significantly (1.41 ± 0.51 to 1.34 ± 0.60; NS). In a subgroup of inflations without ECG signs of ischemia, Ei was decreased without a concomitant decrease in Ai, thus leading to a decrease in the Ei/Ai ratio (1.36 ± 0.43 to 1.17 ± 0.31; p < 0.05). Summarizing the events during PTCA, a steady increase in PCm was observed, whereas the Ei/Ai ratio was slightly decreased. Thus the observation at rest that an elevated PCm was associated with an elevated Ei/Ai was no longer valid during PTCA (Ei/Ai : r = 0.28; NS). A significant correlation was found between parameters of Doppler MF and PCm in patients with ischemic heart disease at rest. During PTCA this relationship was attenuated. Therefore noninvasive assessment of left ventricular filling pressures during acute ischemia by Doppler echocardiography does not seem feasible.