| Background:Epidemiologic data indicate that left ventricular diastolic dysfunction(DD) and diastolic heart failure(DHF),that is symptomatic DD and a distinct form of heart failure,are very common in 40-50%of patients with chronic heart failure have normal or relatively normal left ventricular ejections fractions.Doppler echocardiography has become the most common and important method to evaluate left ventricular diastolic function because of its non-invasion.Early diastolic velocities of mitral annulus(Ea),transmitral diastolic early peak inflow velocity(E),transmitral diastolic late peak inflow velocity(A) and the ratio of mitral velocity to early diastolic velocity of the mitral annulus(E/Ea) can predict left ventricular diastolic function,but the specificity and the sensitivity need to be studied and verified.Therefor,we collection forty patients performed cardiac catheterization for selected coronary artery angiography to measure LVEDP and compared with echocardiographic finding to evaluate the specificity and the sensitivity in predicting LVEDP by echocardiographic finding.Objective:To observe the early diastolic peak velocity of mitral annulus(Ea),the early diastolic peak velocity of the mitral inflow(E)and the late diastolic peak velocity of mitral inflow(A) and the relationship between the velocities and left ventricular end diastolic pressure(LVEDP) which obtained bycardiac catheterization.Methods:Forty patients with repeated chest pain performed cardiac catheterization for selected coronary artery angiography.Patients with the degree of coronary artery stenosis (50%which were diagnosed by cardiac catheterization were as a non-obvious coronary stenosis group.The patients with one or more coronary arteries(the diameter=1.5mm) stenosis =75% were as coronary heart disease group.After the coronary artery angiography,LVEDP were measured and recorded. Echocardiography was performed before 24 hours of the angiography.Left atrial dimensions(LAD),left ventricular end diastolic(LVEDD) and systolic dimension(LVESD), interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT) were measured by echocardiography. Measurements of left ventricular end-diastolic volume (LVEDV),end-systolic volume(LVESV) and ejection fraction(LVEF) was obtained by biplane Simpson's method.The early diastolic peak velocity of mitral annulus(Ea),the early diastolic peak filling velocity of mitral inflow(E),late diastolic peak filling velocity(A) were analyzed.E/Ea ratio and E/A ratio were calculated.SPSS 13.0 software package was used to compare the differences of the parameters between two groups and to analyze the correlation between the LVEDP and the parameters from the echocardiogram.Results:1 There were no statistically significant difference between non-obvious coronary stenosis group and CHD group in age, sex,serum levels of lipid,serum levels of glucose,liver function, renal function,systolic blood pressure and diastolic blood pressure(P>0.05).2 Echocardiographic finding:2.1 Significant more increases were noted in LAD in CHD group than non-obvious coronary stenosis group(30.45±3.49mm, P<0.05).E/Ea ratios in CHD group were significantly higher than those in non-obvious coronary stenosis group(11.68±2.84 vs 8.60±1.90,P<0.05).Compared with the measurements of non-obvious coronary stenosis group increased A and Aa were found in CHD group(P<0.05).2.2 LVEF and E peaks in CHD group were lower than those in non-obvious coronary stenosis group(60.39±10.03 vs 62.67±8.79 and 72.90±11.19 cm/s vs 77.33±7.20 cm/s),but there was no statistical difference between CHD group and non-obvious coronary stenosis group(P>0.05).Compared with non-obvious coronary stenosis group,increased IVST,LVPWT, LVEDD,LVESD,LVEDV and LVESV were found in CHD group,but there was no statistical difference(P>0.05). 2.3 Significant more decreases were noted in Ea,Ea/Aa and E/A in CHD group than non-obvious coronary stenosis group(6.49±1.40cm/s vs 9.36±2.12cm/s,0.79±0.28 vs 1.57±0.63, 1.04±0.17 vsl.20±0.27,P<0.05).2.4 The increase in E/Ea ratio in CHD group was mainly because of the decreased Ea.The decreased Ea was the major reason for decreased Ea/Aa in CHD group,though Aa increase in CHD group at the same time.For decreased E/A in CHD group,the increased A is the major reason.3 Linear correlation analyses:Significant correlations were found between E/Ea ratio and LVEDP(r=0.8175,P<0.05). There was no significant correlations between E/A and LVEDP (r=-0.1260,P>0.05).Correlations were found between LAD and LVEDP(r=0.3777,P<0.05),E/A and LVEDP(r=0.3798,P<0.05).4 The comparison of abnormality incidence rate between E/A,E/Ea and LVEDP.The Sensitivity of E/Ea=10 estimating LVEDP>15mmHg was 94%and was better than 16%of E/A(P<0.05).The specificity of E/Ea=10 predicting LVEDP>15mmHg was 73%and the specificity of E/A was 44%.There was a significant statistical difference in the specificity between E/Ea and E/A.Conclusions:1 Severe coronary stenosis had a great influence on left ventricular diastolic function.2 Doppler echocardiography is an important tool in the evaluation of left ventricular diastolic function.Ea correlates with the degree of left ventricular dysfunction.E/Ea ratio correlates with LVEDP,and the combination of Ea and E/Ea ratio is useful in the evaluation of diastolic function.3 Left atrial size,which correlates with LVEDP,may be an important morphologic index in the estimation of left ventricular diastolic function by combining with other Dopplerechocardiography indexes such as Ea and E/Ea.4 In CHD,E/Ea is more accurate reflection of left ventricular diastolic function than E/A,especially for estimation of LVEDP.
|
PDF Full Text Request