Abstract
Objective—To study indices of diastolic left ventricular function during the first few seconds of myocardial ischaemia.
Design—Isovolumic and total relaxation times and left atrial and left ventricular dP/dt were identified from high fidelity (micromanometer) pressure recordings in the left ventricle and left atrium during percutaneous transluminal angioplasty of the left anterior descending coronary artery.
Patients—20 patients with isolated disease of the left anterior descending artery and normal left ventricular function.
Results—The isovolumic relaxation time lengthened during the first seven to nine seconds of ischaemia; then it shortened by an average of 15% up to the twentieth second, initially as a result of increased left atrial contractility and subsequently because of impaired ventricular relaxation. Ventricular ischaemia resulted in impaired left ventricular diastolic compliance, as shown by an increase in the total relaxation time, before there was evidence of systolic impairment. Minimum dP/dt decreased progressively (by −37% at the twentieth second of ischaemia), whereas maximum dP/dt fell only after 20 seconds of ischaemia (by −11%).
Conclusions—Relaxation and filling of the left ventricle (indices of diastolic function) are more sensitive to myocardial ischaemia than myocardial contractility and systolic function. Left atrial contractility increases during left ventricular ischaemia.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bonow R. O., Bacharach S. L., Green M. V., Kent K. M., Rosing D. R., Lipson L. C., Leon M. B., Epstein S. E. Impaired left ventricular diastolic filling in patients with coronary artery disease: assessment with radionuclide angiography. Circulation. 1981 Aug;64(2):315–323. doi: 10.1161/01.cir.64.2.315. [DOI] [PubMed] [Google Scholar]
- Brutsaert D. L., Rademakers F. E., Sys S. U., Gillebert T. C., Housmans P. R. Analysis of relaxation in the evaluation of ventricular function of the heart. Prog Cardiovasc Dis. 1985 Sep-Oct;28(2):143–163. doi: 10.1016/0033-0620(85)90022-2. [DOI] [PubMed] [Google Scholar]
- Brutsaert D. L., Rademakers F. E., Sys S. U. Triple control of relaxation: implications in cardiac disease. Circulation. 1984 Jan;69(1):190–196. doi: 10.1161/01.cir.69.1.190. [DOI] [PubMed] [Google Scholar]
- Gaasch W. H., Levine H. J., Quinones M. A., Alexander J. K. Left ventricular compliance: mechanisms and clinical implications. Am J Cardiol. 1976 Nov 4;38(5):645–653. doi: 10.1016/s0002-9149(76)80015-x. [DOI] [PubMed] [Google Scholar]
- Hirota Y. A clinical study of left ventricular relaxation. Circulation. 1980 Oct;62(4):756–763. doi: 10.1161/01.cir.62.4.756. [DOI] [PubMed] [Google Scholar]
- Mann T., Goldberg S., Mudge G. H., Jr, Grossman W. Factors contributing to altered left ventricular diastolic properties during angina pectoris. Circulation. 1979 Jan;59(1):14–20. doi: 10.1161/01.cir.59.1.14. [DOI] [PubMed] [Google Scholar]
- Matsuda Y., Toma Y., Ogawa H., Matsuzaki M., Katayama K., Fujii T., Yoshino F., Moritani K., Kumada T., Kusukawa R. Importance of left atrial function in patients with myocardial infarction. Circulation. 1983 Mar;67(3):566–571. doi: 10.1161/01.cir.67.3.566. [DOI] [PubMed] [Google Scholar]
- Papapietro S. E., Coghlan H. C., Zissermann D., Russell R. O., Jr, Rackley C. E., Rogers W. J. Impaired maximal rate of left ventricular relaxation in patients with coronary artery disease and left ventricular dysfunction. Circulation. 1979 May;59(5):984–991. doi: 10.1161/01.cir.59.5.984. [DOI] [PubMed] [Google Scholar]
- Rousseau M. F., Veriter C., Detry J. M., Brasseur L., Pouleur H. Impaired early left ventricular relaxation in coronary artery disease: effects of intracornary nifedipine. Circulation. 1980 Oct;62(4):764–772. doi: 10.1161/01.cir.62.4.764. [DOI] [PubMed] [Google Scholar]
- Sigwart U., Grbic M., Goy J. J., Kappenberger L. Left atrial function in acute transient left ventricular ischemia produced during percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery. Am J Cardiol. 1990 Feb 1;65(5):282–286. doi: 10.1016/0002-9149(90)90288-c. [DOI] [PubMed] [Google Scholar]
- Strobeck J. E., Bahler A. S., Sonnenblick E. H. Isotonic relaxation in cardiac muscle. Am J Physiol. 1975 Sep;229(3):646–651. doi: 10.1152/ajplegacy.1975.229.3.646. [DOI] [PubMed] [Google Scholar]
- Weisfeldt M. L., Scully H. E., Frederiksen J., Rubenstein J. J., Pohost G. M., Beierholm E., Bello A. G., Daggett W. M. Hemodynamic determinants of maximum negative dP-dt and periods of diastole. Am J Physiol. 1974 Sep;227(3):613–621. doi: 10.1152/ajplegacy.1974.227.3.613. [DOI] [PubMed] [Google Scholar]
- Weiss J. L., Frederiksen J. W., Weisfeldt M. L. Hemodynamic determinants of the time-course of fall in canine left ventricular pressure. J Clin Invest. 1976 Sep;58(3):751–760. doi: 10.1172/JCI108522. [DOI] [PMC free article] [PubMed] [Google Scholar]