Author + information
- Received October 17, 1989
- Revision received November 16, 1990
- Accepted January 10, 1991
- Published online July 1, 1991.
- Charles F. Presti, MD1,
- Ann D. Walling, MD1,
- Irma Montemayor, MD1,
- James M. Campbell, MD1 and
- Michael H. Crawford, MD, FACC*,1
- ↵*Address for reprints: Michael H. Crawford, MD, Division of Cardiology, University of New Mexico, School of Medicine, Albuquerque, New Mexico 87131.
Previous studies using Doppler echocardiography to evaluate left ventricular diastolic filling have shown that myocardial ischemia induced by coronary balloon angioplasty or atrial pacing results in a decrease in the left ventricular inflow peak early (E) to peak atrial (A) velocity ratio. To investigate the effects of exerciseinduced ischemia on Doppler-derived filling variables, 20 patients with coronary artery disease and exercise-induced electrocardiographic changes and regional wall motion abnormalities determined by two-dimensional echocardiography were evaluated and compared with 20 patients without evidence of exercise-induced ischemia. Doppler echocardiography was performed at rest and immediately after exercise before the resolution of exercise-induced wall motion abnormalities.
Peak E and A velocities increased from rest to postexercise in both the ischemic and nonischemic groups, although the ischemic group demonstrated a greater increase in peak E velocity (from 68 ± 15 cm/s at rest to 88 ± 22 cm/s after exercise) than the nonischemic group (70 ± 13 to 77 ± 18 cm/s) (p < 0.05 for the difference in response between groups). Accompanying these changes was a slight increase in the peak E/A velocity ratio in the ischemic group (1.04 ± 0.28 at rest to 1.13 ± 0.42 after exercise) versus a decrease in the nonischemic group (1.07 ± 0.30 to 0.90 ± 0.28) (p < 0.05 intergroup difference). Within the ischemic group, the change from rest to postexercise in peak E/A velocity ratio was related to changes in left ventricular wall motion score (r = 0.61, p = 0.004) and inversely to changes in left ventricular ejection fraction (r = −0.61, p = 0.004) but not to changes in heart rate (r = −0.30, p = NS).
This study demonstrates that during exercise-induced ischemia, early diastolic filling is not blunted but is instead maintained. This observation correlates with changes in left ventricular systolic function, suggesting that exercise-induced ischemia may lead to greater increases in left atrial pressure, which augments peak E velocity and results in pseudonormalization of the diastolic Doppler velocity profile.
- Received October 17, 1989.
- Revision received November 16, 1990.
- Accepted January 10, 1991.
- American College of Cardiology Foundation