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KMID : 0378020090520030038
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New Medical Journal
2009 Volume.52 No. 3 p.38 ~ p.46
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Significance of Diastolic Dysfunciton in 2-Dimensional Echocardiography in the Angina with Normal Left Ventricular (LV) Regional Wall Motion and Normal LV Systolic Function
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Yang Po-Song
Her Sung-Ho
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Abstract
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Objectives and Background: Left ventricular (LV) diastolic dysfunction in 2-dimensional echocardiography may be encountered in chronic stable angina (SA) and unstable angina (UA) patients with normal LV regional wall motion and normal LV systolic function. The goals of this study were to assess the frequency and the value of LV diastolic dysfunction in the SA and UA treated by percutaneous coronary intervention (PCI).
Methods and Results: We studied 283 patients of normal control group by the angiography, and studied 308 patients of SA and 192 patients of UA who had no history or electrocardiographic evidence of myocardial infarction who subsequently treated by PCI. We excluded the presence of resting wall motion abnormalities (WMA) and the below 50% (< 50%) of LV ejection fraction in 2-dimensional echocardiography. Each patients underwent pulsed-wave Doppler examination of mitral inflow before and during Valsalva maneuver and of pulmonary venous inflow and Doppler tissue imaging of the mitral annulus. Diastolic function was categorized according to the progression of diastolic dysfunction: normal; mild, defined as impaired relaxation without evidence of increased filling pressure; moderate, defined as impaired relaxation associated with moderate elevation of filling pressures or pseudonormal filling, and severe, defined as advanced reduction in compliance or reversible or fixed restrictive filling. We divided 2 groups in normal to mild LV diastolic dysfunction and moderate to severe dysfunction by Doppler criteria. Moderate to severe LV diastolic dysfunction was detected in 35 patients (12.5%) of normal control group, 41 patients (13.3%) of SA and 33 patients (17.1%) of UA. There were significant difference for LV diastolic dysfunction between the normal control group and UA (12.5% vs 17.1%, p=0.021, odds ratio; 1.453), but no significant difference between the normal control group and SA (12.5% vs 13.3%, p=0.475, odds ratio; 1.075).
Conclusions: Moderate and severe LV diastolic dysfunction in UA with normal LV systolic function and normal LV regional wall motion is an independent predictor and a higher prevalence compared with moderate and severe LV diastolic dysfunction in the normal coronary angiographic group.
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KEYWORD
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Diastolic dysfunction, Angina
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