Doppler-derived peak filling gradient and rate as sensitive indexes for evaluating improvement of left ventricular diastolic function after successful percutaneous transluminal coronary angioplasty

To evaluate the effects of successful percutaneous transluminal coronary angioplasty (PTCA) on left ventricular (LV) systolic and diastolic function, 11 patients with coronary artery disease were studied by Doppler echocardiography pre- and post-PTCA (7 ± 8 days). Another 22 age-matched normal subjects served as controls in this retrospective study. LV ejection fraction was derived utilizing biplane Simpson's rule method. Transaortic systolic and transmitral diastolic flow velocity were recorded for calculation of the peak and mean gradient, ratio of diastolic early peak (E) to late peak (A) velocity, normalized peak filling rate computed as E times mitral valve area (by pressure half-time method) divided by LV end-diastolic volume. All patients had successful PTCA with 63 ± 29% increase in angiographic luminal diameter and 21 ± 10% residual stenosis. Patients with significant coronary artery stenosis before PTCA had a lower transmitral diastolic peak and mean gradient and normalized peak filling rate than those of age-matched controls (p < 0.05). After successful PTCA, transmitral diastolic peak gradient (2.5 ± 0.9 vs. 3.4 ± 1.4 mmHg, pre- vs. post-PTCA), peak filling rate (347 ± 137 vs. 465 ± 168 ml/s), normalized peak filling rate (2.45 ± 1.25 vs. 3.06 ± 1.23 s^-1), and ratio of E to A (1.0 ± 0.3 vs. 1.5 ± 0.5) increased significantly, whereas transaortic systolic hemodynamic measurements and LV ejection fraction did not change signficantly. Thus, Doppler echocardiography can provide sensitive indexes, especially of diastolic filling gradient and rates for follow-up evaluation of LV diastolic function after PTCA.