CLINICAL RESEARCH: CARDIAC FUNCTION
Lack of Inertia Force of Late Systolic Aortic Flow Is a Cause of Left Ventricular Isolated Diastolic Dysfunction in Patients With Coronary Artery Disease
Takayuki Yoshida, MD,
Nobuyuki Ohte, MD, FACC*,
Hitomi Narita, MD,
Seiichiro Sakata, MD,
Kazuaki Wakami, MD,
Kaoru Asada, MD,
Hiromichi Miyabe, MD,
Tomoaki Saeki, MD and
Genjiro Kimura, MD
Department of Internal Medicine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Manuscript received January 23, 2006;
revised manuscript received April 14, 2006,
accepted April 17, 2006.
* Reprint requests and correspondence: Dr. Nobuyuki Ohte, Department of Internal Medicine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. (Email: ohte{at}med.nagoya-cu.ac.jp).
OBJECTIVES: We investigated whether a lack of inertia force of late systolic aortic flow and/or apical asynergy provoke early diastolic dysfunction in patients with coronary artery disease (CAD).
BACKGROUND: Left ventricular (LV) isolated diastolic dysfunction is a well-recognized cause of heart failure.
METHODS: We evaluated LV apical wall motion and obtained left ventricular ejection fraction (LVEF) by left ventriculography in 101 patients who underwent cardiac catheterization to assess CAD. We also computed the LV relaxation time constant (Tp) and the inertia force of late systolic aortic flow from the LV pressure (P)–first derivative of left ventricular pressure (dP/dt) relation. Using color Doppler echocardiography, we measured the propagation velocity of LV early diastolic filling flow (Vp). Patients with LVEF  50% (preserved systolic function [PSF], n = 83) were divided into 2 subgroups: patients with inertia force (n = 53) and without inertia force (n = 30). No patient with systolic dysfunction (SDF) (LVEF <50%) had inertia force (n = 18).
RESULTS: The Tp was significantly longer in patients with SDF (85.7 ± 21.0 ms) and with PSF without inertia force (81.1 ± 23.6 ms) than in those with PSF with inertia force (66.3 ± 12.8 ms) (p < 0.001). The Vp was significantly less in the former 2 groups than in the last group. In patients with PSF, LV apical wall motion abnormality was less frequently observed in those with inertia force than in those without (p < 0.0001).
CONCLUSIONS: An absence of inertia force in patients with PSF is one of the causes of isolated diastolic dysfunction in patients with CAD. Normal LV apical wall motion is substantial enough to give inertia to late systolic aortic flow.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | dP/dt = first derivative of left ventricular pressure | | E/A = ratio of peak flow velocity during early diastole to peak flow velocity during atrial contraction | | Em = peak mitral annular velocity during early diastole | | IQR = interquartile range | | LV = left ventricle/ventricular | | LVEF = left ventricular ejection fraction | | MI = myocardial infarction | | PSF = preserved systolic function | | SDF = systolic dysfunction | | Sm = peak mitral annular velocity during systole | | Tp = LV relaxation time constant obtained from LV pressure—dP/dt relation | | Tw = LV relaxation time constant obtained by the method proposed by Weiss et al. (18) | | Vp = propagation velocity of early diastolic filling flow |
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