LEFT-VENTRICULAR DIASTOLIC DYSFUNCTION AFTER MYOCARDITIS - EXERCISE ECHOCARDIOGRAPHIC AND DOPPLER-ECHOCARDIOGRAPHIC EVALUATION

From 23 patients with bioptically proven floride or healing myocarditis, 5 (21%) had - after 3 +/- 0.5 years - a systolic dysfunction at rest (NYHA III-IV) with dilatation, global hypokinesia and reduction of the ejection fraction of the left ventricle. 18 patients (79%) (NYHA I-II) had normal systolic function at rest and under exercise conditions, normal pericardial and valvular structures and no valvular regurgitation in Doppler echocardiography. Two-dimensional and pulsed Doppler echocardiographic assessment was performed at rest, during and 6 min after bicycle exercise in comparison to a normal control group (n = 10). In patients with normal systolic function (n = 18) after myocarditis, indexes of left ventricular diastolic function differed significantly under exercise conditions from the normal control group, with marked prolongation of acceleration time (AT) (78 +/- 15 vs. 53 +/- 11 ms; p < 0.01), as well as reduced peak of early diastolic filling velocity (VE) (0.40 +/- 0.13 vs. 0.97 +/- 0.23 m/s; p < 0.01), reduced ratio of early to late diastolic flow velocity (VE/VA) (0.81 +/- 0.17 vs. 1.33 +/- 0.23 m/s: p < 0.01). and prolonged deceleration pressure halftime (DHT) (42 +/- 12 vs. 26 +/- 3 ms; p < 0.01). Patients with impaired left ventricular systolic function showed false negative pattern of diastolic function at rest and under exertion. It is concluded that patients with normal systolic function after myocarditis and mild symptoms of heart failure have a diastolic dysfunction with impairment of left ventricular relaxation.