LEFT-VENTRICULAR DIASTOLIC FILLING IN PATIENTS WITH CORONARY-ARTERY DISEASE WITHOUT MYOCARDIAL-INFARCTION

Left ventricular diastolic dysfunction at rest was studied in 24 patients with coronary artery disease but no evidence of previous myocardial infarction. Seven patients with normal coronary arteries were studied as control. Diastolic filling was analyzed by the serial left ventricular volume and 14 radial axes from the gravity point of the left ventricle with cine left ventriculography. There were no differences in the systolic function between coronary artery disease and the normal control. Peak filling rate was decreased significantly in the groups with left anterior descending artery disease (LAD, p < 0.05) and multivessel disease (MVD, p < 0.05), but not in the group with right coronary artery disease (RCA). Time to peak filling rate was prolonged in each group of LAD (p < 0.05), RCA (p < 0.05), and MVD (p < 0.001), compared with controls. The time-volume curve showed disturbed rapid filling in the LAD and RCA groups, and also both depressed rapid and slow filling in the MVD group. In the LAD group, the filling fraction was decreased significantly at the time of 25% of the diastolic period (p < 0.001) and radial distension to the anterior wall was decreased at the time of 25%, 50%, and 75% of the diastolic period, compared with controls. In the RCA group, the filling fraction (p < 0.001) and radial distension to the posterior wall were decreased only at the time of 25% of the diastolic period. In the MVD group, filling fraction and radial distension to the most wall were decreased at 25%, 50%, and 75% of the diastolic period. In every group of coronary artery disease the deceased filling fraction and radial distension disappeared at end-diastole. The results showed that, in patients with angina pectoris, the distension of regional ischemic myocardium might be impaired relatively early in diastole and might cause impairment of global left ventricular filling.