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Kim, Kim, Kim, Rhew, Bae, Seo, Gill, Park, Jeong, Cho, Park, and Kang: A Study on The Left Ventricular Diastolic Dysfunction in Ischemic Heart Disease – Influence of Left Ventricular Diastolic Dysfunction on Left Atrium –
Original Article

J Korean Soc Echocardiogr 1995;3(2):121-129.

Published online: 18 February 1995

DOI: https://doi.org/10.3803/jkes.1995.3.2.121

A Study on The Left Ventricular Diastolic Dysfunction in Ischemic Heart Disease – Influence of Left Ventricular Diastolic Dysfunction on Left Atrium –

Joon Woo Kim, M.D., Joo Han Kim, M.D., Sung Hee Kim, M.D., Jay Young Rhew, M.D., Youl Bae, M.D., Jeong Pyeong Seo, M.D., Gwang Chae Gill, M.D., Joo Hyung Park, M.D., Myung Ho Jeong, M.D., Jeong Gwan Cho, M.D., Jong Chun Park, M.D., Jung Chaee Kang, M.D.

Division of Cardiology, Department of Internal Medicine, Chonnam University Medical School, Kwangju, Korea

Copyright © 1995 Korean Society of Echocardiography

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Diastolic dysfunction of left ventricle appears to be one of the earliest detectable abnormalities in a number of disorders. The aims of this study is to evaluate the influence of left ventricular diastolic dysfunction on left atrial function in patients with ischemic heart diseases.

Method

Echocardiography, coronary and left ventricular(LV) angiography and LV catheterization were performed in 43 patients with ischemic heart disease to assess the influence of left ventricular(LV) diastolic dysfunction on left atrial function. They were divided to two groups by the absolute increase in left ventricular pressure during left atrial contraction(A amplitude; Group I: > 5mmHg, Group II: < 5mmHg).

Results

There were no significant difference in severity of coronary arterial lesions and Doppler echocardiographic parameters between the two groups. In M-mode echocardiography, left atrial dimensions were measured at presystole(Al), early diastole(A2), and before and after left atrial contraction (A3, A4). In Group I, Al was 37.3 ± 5.1mm, A2 was 33.8 ± 5.2mm, A3 was 34.4 ± 5.5mm, and A4 was 29.3 ± 5.0mm. In Group II, Al, 37.0 ± 4.1mm, A2, 33. 2 ± 4.9mm, A3, 34.1 ± 4.3mm, and A4, 28.5 ± 4.6mm. The fractional shortening of early and late diastolic phase of left atrium[Fl = (A1-A2)/A1 × 100), F2 = ((A3-A4)/A3× 100)] by the formula were 9.4 ± 5.1 %, 14.9 ± 6.7 % each, in Group I. In Group II, 12.1 ± 7.3 %, 20.6 ± 10.2 % each. F2 was higher in Group II (p < 0.05). Left ventricular end diastolic pressure(LVEDP), LV pressure just before atrial contraction(Pre-A pressure) and absolute increase in left ventricular pressure during left atrial contraction(A amplitude) were more higher in group 1 (Group I: 18.4 ± 7.9mmHg, 10.0 ± 5.7mmHg, 10.3 ± 4.4mmHg, Group 11: 9.77 ± 5.4mmHg, 6.5 ± 4.1mmHg, 3.5 ± 1.6mmHg, p < 0.0005, p <0.05, p < 0.0001). There was a good negative correlation between A amplitude and F2(r = – 0.42, p < 0.005).

Conclusion

In patients with ischemic heart disease, LVEDP was higher and left ventricular ejection fraction and late diastolic fractional shortening of left atrium were lower in group with higher A amplitude. Thus, left atrial systolic function was reduced in proportion to left ventricular stiffness.

Keywords: Ischemic heart disease, Left ventricular stiffness, Left atrial systolic function.

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Fig. 1.
The left ventricular pressure recording illustrating pressure measurements in this study. These included left ventricular pressure just before atrial contraction(pre-A), left ventricular end diastolic pressure(LVEDP) and the absolute pressure increase in left ventricle that occurred as a result of left atrial contraction(A amp.).
jkse-3-121f1.tif
Fig. 2.
Measurements of the left atrial dimensions in M-mode echocardiography, left atrial dimensions were measured at presystole(A1), early diastole(A2), and before and after left atrial contraction(A3, A4). a: interval between R wave and closure of aortic valve.
jkse-3-121f2.tif
Fig. 3.
The Doppler echocardiographic recording of transmitral flow illustrating several of the Doppler variables measured in this study. E: peak velocity of early mitral flow, A: peak velocity of late mitral flow, IVRT: isovolumic relaxation time, A dur.: duration of late mitral flow. DT: deceleration time of mitral flow b: interval between R wave and onset of E wave.
jkse-3-121f3.tif
Fig. 4.
The correlation between the absolute increase in left ventricular pressure during atrial contraction(A amplitude) and the fractional shortening of late diastolic phase of left atrium(F2). This figure shows a good negative correlation between them.
jkse-3-121f4.tif
Table 1.
Clinical and angiographic findings
  Group I (A amp. > 5mmHg) Group II (A amp. < 5mmHg) difference
Number 19 24  
Sex(male: female) 1.7: 1 1: 1 NS
Age(years) 56.5 ± 9.3 55.7 ± 11.4 NS
Diagnosis     p < 0.05
stable angina 6 12  
unstable angina 4 9  
acute Ml 9 2  
old Ml   1  
Coronary angiogram     NS
normal 6 10  
1 – vessel disease 8 11  
2 – vessel disease 4 1  
3 – vessel disease 1 2  

MI: myocardial infarction, NS: not significant

Table 2.
Comparison of left ventricular angiography and cardiac catheterization findings between two groups
  Group I (A amp. > 5mmHg) Group II (A amp. < 5mmHg) difference
LVEDV(ml/m2) 104.0 ± 28.6 95.8 ± 28.9 NS
LVESV(ml/m2) 43.9 ± 16.3 32.0 ± 10.5 0.05
Stroke volume(ml/m2) 60.1 ± 20.6 64.3 ± 26.1 NS
Ejection fraction(%) 57.2 ± 13.0 68.8 ± 9.8 0.05
LVEDP(mmHg) 18.4 ± 7.9 9.8 ± 4.1 0.0005
Pre-A pressure(mmHg) 10.0 ± 5.7 6.5 ± 4.1 0.05
A amplitude (mmHg) 10.3 ± 4.4 3.5 ± 1.6 0.00001

LVED(S)V: left ventricular end-diastolic(systolic) volume,

LVEDP: left ventricular end-diastolic pressure NS: not significant

Table 3.
Comparison of m-mode echocardiographic findings between two groups
  Group I (A amp. > 5mmHg) Group II (A amp. < 5mmHg) difference
A1(mm) 37.3 ± 5.1 37.0 ± 4.1 NS
A2(mm) 33.8 ± 5.2 33.2 ± 4.9 NS
A3(mm) 34.4 ± 5.5 34.1 ± 4.3 NS
A4(mm) 29.3 ± 5.0 28.5 ± 4.6 NS
F1(%) 9.4 ± 5.1 14.9 ± 6.7 NS
F2(%) 12.1 ± 7.3 20.6 ± 10.2 0.05

A1, A2, A3, A4: left atrial dimensions at presystole, early diastole, and before and after left atrial contraction, respectively: F1, F2: fractional shortening of early and late diastolic phase of left atrium, respectively: F1 = ((A1-A2)/A1 × 100), F2 = ((A3-A4)/A3×100).

Table 4.
Comparison of doppler echocardiographic findings between two groups
  Group I (A amp. ≥ 5mmHg) Group II (A amp. < 5mmHg) difference
E velocity(m/sec) 0.67 ± 0.17 0.62 ± 0.14 NS
A velocity(m/sec) 0.71 ± 0.17 0.73 ± 0.22 NS
E/A 0.98 ± 0.33 0.89 ± 0.31 NS
IVRT(ms) 118.4 ± 27.3 121.0 ± 28.1 NS
DT(ms) 179.1 ± 44.6 200.3 ± 47.0 NS
AD(ms) 141.4 ± 25.4 143.4 ± 26.0 NS

I VRT: isovolumic relaxation time, DT: deceleration time, AD: A wave duration, NS: not significant

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