Abstract
OBJECTIVE--To assess the sensitivities of Doppler indices to changes in global cardiac function during and after controlled myocardial ischaemia induced by coronary angioplasty. DESIGN--Continuous wave Doppler signals of aortic flow were recorded during coronary angioplasty. The following Doppler indices of cardiac function were measured before, during, and after balloon inflation: V (peak velocity), MA (mean acceleration), V2/T (T = time from onset to peak ejection), and MD (minute distance corrected for baseline heart rate). SETTING--A tertiary care cardiological unit in a university hospital. PATIENTS--Sixteen patients undergoing coronary angioplasty of the left anterior descending coronary artery. Eight patients had multivessel disease. MAIN OUTCOME MEASURES--The primary outcome measures were planned before data collection began. RESULTS--12 patients showed a significant fall of three or more Doppler indices from their baseline values during balloon inflation. This occurred in all patients with multivessel disease. The Doppler indices V2 T, MD, V, and MA fell by 43.7%, 37.7%, 27.4%, and 23% respectively from their baseline values (p less than 0.0001). The relative sensitivities of the Doppler indices to ischaemia were V2/T greater than MD (p less than 0.02), MD greater than (p less than 0.001), and V greater than MA (p less than 0.01). The impairment of global left ventricular function resulting from brief balloon inflation during single vessel angioplasty was reversible in all the patients. CONCLUSIONS--The Doppler indices V2/T, MD, V, and MA are all sensitive, in order of magnitude, to falls in global cardiac function resulting from ischaemia. They may prove useful for assessing cardiac function during ischaemia in the clinical setting.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Alam M., Khaja F., Brymer J., Marzelli M., Goldstein S. Echocardiographic evaluation of left ventricular function during coronary artery angioplasty. Am J Cardiol. 1986 Jan 1;57(1):20–25. doi: 10.1016/0002-9149(86)90944-6. [DOI] [PubMed] [Google Scholar]
- Bryg R. J., Labovitz A. J., Mehdirad A. A., Williams G. A., Chaitman B. R. Effect of coronary artery disease on Doppler-derived parameters of aortic flow during upright exercise. Am J Cardiol. 1986 Jul 1;58(1):14–19. doi: 10.1016/0002-9149(86)90233-x. [DOI] [PubMed] [Google Scholar]
- Carlson E. B., Hinohara T., Morris K. G. Recovery of systolic and diastolic left ventricular function after a 60-second coronary arterial occlusion during percutaneous transluminal coronary angioplasty for angina pectoris. Am J Cardiol. 1987 Sep 1;60(7):460–466. doi: 10.1016/0002-9149(87)90286-4. [DOI] [PubMed] [Google Scholar]
- Harrison M. R., Smith M. D., Friedman B. J., DeMaria A. N. Uses and limitations of exercise Doppler echocardiography in the diagnosis of ischemic heart disease. J Am Coll Cardiol. 1987 Oct;10(4):809–817. doi: 10.1016/s0735-1097(87)80274-7. [DOI] [PubMed] [Google Scholar]
- Hauser A. M., Gangadharan V., Ramos R. G., Gordon S., Timmis G. C. Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. J Am Coll Cardiol. 1985 Feb;5(2 Pt 1):193–197. doi: 10.1016/s0735-1097(85)80036-x. [DOI] [PubMed] [Google Scholar]
- Khaja F., Sabbah H. G., Brymer J. F., Stein P. D. Influence of coronary collaterals on left ventricular function in patients undergoing coronary angioplasty. Am Heart J. 1988 Nov;116(5 Pt 1):1174–1180. doi: 10.1016/0002-8703(88)90436-x. [DOI] [PubMed] [Google Scholar]
- Labovitz A. J., Lewen M. K., Kern M., Vandormael M., Deligonal U., Kennedy H. L. Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty. J Am Coll Cardiol. 1987 Oct;10(4):748–755. doi: 10.1016/s0735-1097(87)80266-8. [DOI] [PubMed] [Google Scholar]
- Mathias D. W., Wann L. S., Sagar K. B., Klopfenstein H. S. The effect of regional myocardial ischemia on Doppler echocardiographic indexes of left ventricular performance: influence of heart rate, aortic blood pressure, and the size of the ischemic zone. Am Heart J. 1988 Oct;116(4):953–960. doi: 10.1016/0002-8703(88)90145-7. [DOI] [PubMed] [Google Scholar]
- Mehta N., Bennett D., Mannering D., Dawkins K., Ward D. E. Usefulness of noninvasive Doppler measurement of ascending aortic blood velocity and acceleration in detecting impairment of the left ventricular functional response to exercise three weeks after acute myocardial infarction. Am J Cardiol. 1986 Nov 1;58(10):879–884. doi: 10.1016/s0002-9149(86)80003-0. [DOI] [PubMed] [Google Scholar]
- Norell M. S., Lyons J. P., Gershlick A. H., Gardener J. E., Rothman M. T., Layton C. A., Balcon R. Assessment of left ventricular performance during percutaneous transluminal coronary angioplasty: a study by intravenous digital subtraction ventriculography. Br Heart J. 1988 Apr;59(4):419–428. doi: 10.1136/hrt.59.4.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pagani M., Vatner S. F., Baig H., Braunwald E. Initial myocardial adjustments to brief periods of ischemia and reperfusion in the conscious dog. Circ Res. 1978 Jul;43(1):83–92. doi: 10.1161/01.res.43.1.83. [DOI] [PubMed] [Google Scholar]
- Rentrop K. P., Cohen M., Blanke H., Phillips R. A. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985 Mar;5(3):587–592. doi: 10.1016/s0735-1097(85)80380-6. [DOI] [PubMed] [Google Scholar]
- Sabbah H. N., Przybylski J., Albert D. E., Stein P. D. Peak aortic blood acceleration reflects the extent of left ventricular ischemic mass at risk. Am Heart J. 1987 Apr;113(4):885–890. doi: 10.1016/0002-8703(87)90048-2. [DOI] [PubMed] [Google Scholar]
- Serruys P. W., Wijns W., van den Brand M., Meij S., Slager C., Schuurbiers J. C., Hugenholtz P. G., Brower R. W. Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty. Circulation. 1984 Jul;70(1):25–36. doi: 10.1161/01.cir.70.1.25. [DOI] [PubMed] [Google Scholar]
- Wallmeyer K., Wann L. S., Sagar K. B., Kalbfleisch J., Klopfenstein H. S. The influence of preload and heart rate on Doppler echocardiographic indexes of left ventricular performance: comparison with invasive indexes in an experimental preparation. Circulation. 1986 Jul;74(1):181–186. doi: 10.1161/01.cir.74.1.181. [DOI] [PubMed] [Google Scholar]
- Wohlgelernter D., Cleman M., Highman H. A., Fetterman R. C., Duncan J. S., Zaret B. L., Jaffe C. C. Regional myocardial dysfunction during coronary angioplasty: evaluation by two-dimensional echocardiography and 12 lead electrocardiography. J Am Coll Cardiol. 1986 Jun;7(6):1245–1254. doi: 10.1016/s0735-1097(86)80143-7. [DOI] [PubMed] [Google Scholar]
