Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris or acute myocardial infarction

The effect of percutaneous transluminal coronary angioplasty (PTCA) on left ventricular (LV) diastolic function has not been systematically investigated in patients treated for unstable angina or ischemia after acute myocardial infarction (AMI). To assess the relation between reduction of stenosis severity and improvement in diastolic function in this setting, 42 patients with either unstable angina (n = 22) or post-AMI ischemia (n = 20) were serially monitored by Doppler echocardiography 8 ± 5 hours before and 2 ± 1 days after PTCA. Doppler LV filling indexes included isovolumic relaxation time, mitral deceleration time, E A peak velocity ratio and atrial filling fraction. Eighteen agedmatched control subjects served to establish normal values for comparison. Before PTCA, both groups exhibited abnormal diastolic function demonstrated by prolonged isovolumic relaxation time and mitral deceleration time, decreased E A ratio and increased atrial filling fraction. After PTCA isovolumic relaxation time and deceleration time decreased 18 ± 28 (p < 0.005) and 33 ± 43 ms (p < 0.002) in the unstable angina group and 18 ± 23 (p < 0.003) and 14 ± 34 ms (difference not significant), respectively, in the post-AMI ischemia group. An increase in E A ratio and a decrease in atrial filling fraction occurred in both groups; however, these changes were significant only in patients with post-AMI ischemia (+21%, p < 0.03 and -11.4%, p < 0.005, respectively). Early infarct vessel PTCA (defined as within 14 days of AMI, n = 10) was associated with improvement in LV filling reflected by increased E A ratio (1.1 ± 0.4 to 1.4 ± 0.9, p < 0.05) and decreased atrial filling fraction (41 ± 7 to 35 ± 10, p < 0.02) not seen with later revascularization. Thus, PTCA may produce significant improvement in Doppler indexes of LV filling as early as 2 days after revascularization in patients with severe ischemia. In the setting of recurrent ischemia after AMI, an opportunity may exist during which early PTCA can lead to improvement in LV filling characteristics.