Interrelationship of regional systolic wall motion with changes in left ventricular diastolic filling and global systolic function following coronary angioplasty

This study prospectively assessed the effect of initial regional systolic wall motion on the degree of diastolic function impairment, as well as its influence on improvement of diastolic filling and systolic function, following percutaneous transluminal coronary angioplasty. Doppler echocardiography was performed within 24 hours before, and 2 days following, coronary balloon angioplasty in 25 consecutive patients, and randomly in 20 age-matched normal subjects. Seven patients with normal regional systolic wall motion (Group A) had normal left ventricular ejection fractions, but demonstrated reduced (p < 0.05) normalized peak filling rate and transmitral peak gradient, as compared with normal control group (0.64±0.07 vs. 0.66±0.06, 2.12±0.53 vs. 3.16±1.00 s^-1 and 2.7±0.7 vs. 4.5±1.7 mmHg, respectively). Patients with abnormal regional systolic wall motion demonstrated lower left ventricular ejection fraction and a greater reduction in normalized peak filling rate and transmitral peak gradient, as compared with Group A patients (0.45±0.18, 1.87±0.57 s^-1, and 1.9±1.2 mmHg); and only these patients demonstrated improvement (p < 0.05) following the angioplasty (0.49±0.18, 2.24±0.54 s^-1, and 2.3±1.2 mmHg, respectively). In 8 patients abnormal regional systolic wall motion improved following the angioplasty (subgroup B(i)) and in 10 it did not (subgroup B(n)). Improvement (p < 0.05) after coronary angioplasty in left ventricular ejection fraction, normalized peak filling rate, and transmitral peak gradient was seen only in subgroup B(i) (0.39±0.19 vs. 0.44±0.17, 1.56±0.47 vs. 2.05±0.43 s^-1 and 1.6±1.4 vs. 2.5±1.4 mmHg, respectively). The data indicate that an abnormal regional systolic wall motion identifies patients with the greatest diastolic filling and systolic dysfunction. Improvement in regional systolic wall motion following the angioplasty identifies those who have potential for an early improvement of global systolic and diastolic filling function.