Asynchronous Left Ventricular Diastolic Filling in Patients with One-Vessel Coronary Artery Disease

Left ventricular diastolic filling has been reported to be impaired in many patients with coronary artery disease. To study the relation between global and regional filling of LV, resting ECG-gated pool study was performed in 22 normal subjects and 24 patients with angina pectoris with isolated stenosis (＞75%) of proximal LAD but without myocardial infarction. A computer program subdivided LV into four regions and the time-activity curves and the first derivative curves were computed in global LV and in each region (septal, apical and lateral region). End-systole of each region occurred very close to global end-systole in both groups. In global LV, peak filling rate was decreased (p＜.001) and the time to peak filling rate, measured from global end-systole to peak filling rate, was prolonged (p＜.001) in patients with angina pectoris than in normal subjects. In the septal and apical sides perfused by stenosed vessel, peak filling rates were slightly decreased in apical region (p＜.02), but not in septal region (p=NS), and time to peak filling rates were prolonged in apical (p＜.001) and in septal region (p＜.001) in patients with angina pectoris compared with normal subjects. In the normally perfused lateral side, there were no differences in peak filling rate and in time to peak filling rate between both groups. Total | dt |, which was defined as the sum of the time differences from global to regional peak filling rate, was significantly greater in patients with angina pectoris than normal subjects (45±17, 85±25 msec, p＜.001). This indicates the presence of asynchronous diastolic filling in the different regions of LV in patients with angina pectoris. A negative correlation existed between total | dt | and global peak filling rate (r=-0.64, p＜.001). Thus, in patients with angina pectoris, asynchronous filling occurs due to the filling disturbance in the affected sides, which impairs the filling of global LV.