Transmitral flow velocities and times during stress transthoracic echocardiography in patients with myocardial ischaemia.

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Twenty-nine men with chronic stable angina pectoris were investigated using stress electrocardiography (ECG) and stress transthoracic echocardiography by means of transoesophageal stimulation of the left atrium. At rest and after each stimulated frequency, ECG and 2-dimensional echocardiography combined with Doppler were performed simultaneously. Fourteen patients without ischaemia at stress ECG and two patients who were subjected only to two different frequencies of stimulation were excluded from our study. Thirteen patients with ischaemic electrocardiographic response at stress, who were subjected to at least three stimulated frequencies, were evaluated. Their deceleration time of early transmitral filling was prolonged from 171 +/- 15.4 ms to 178.1 +/- 14.4 ms (P = ns) after the first stimulated frequency, to 172.8 +/- 15.1 ms after the second stimulated frequency (P = ns) and was shortened to 143.6 +/- 7.9 ms (P < 0.05) after the fastest stimulated frequency. The ratio of peak transmitral flow velocity in early diastole (E) to that during atrial contraction (A) decreased from 0.93 +/- 0.07 at rest to 0.85 +/- 0.07 (P < 0.05) after the first stimulated frequency, to 0.87 +/- 0.07 (P = ns) after the second stimulated frequency and increased to 1.13 +/- 0.08 (P < 0.05) after the fastest stimulated frequency. In patients with angina pectoris and myocardial ischaemia, the changes in the E/A ratio and deceleration time during stress are not linear and their direction depends on the moment of their evaluation. Their use for the quantitative evaluation of the diastolic function of the left ventricle is problematic.