Left Ventricular Systolic and Diastolic Function in Patients with Effort Angina Pectoris

In order to investigate the left ventricular (LV) systolic and diastolic function in patients with effort angina pectoris (AP), left ventriculography was performed in 9 normal subjects (N) and 14 AP patients with isolated left anterior descending (LAD) coronary artery disease. LV volume (V), regional area (S) [anterior,apical and inferior region] and the first derivative of V and S(dV/dt, dS/dt) were derived from the frame-by-frame analysis of left ventriculogram. Peak ejection rate (PER), peak filling rate (PFR) and peak atrial filling rate (PAFR) were derived from dV/dt and normalized for end-diastolic volume (nPER,nPFR and nPAFR). The ratio of filling volume to stroke volume during rapid filling and atrial contraction phase were defined as rapid filling fraction (RFF) and atrial filling fraction (AFF). Likewise, indices of each region were derived from S and dS/dt. We also calculated global and regional ejection fraction (EF), mean normalized systolic ejection rate (MNSER), time constant (T), and global and regional indices of compliance at end-diastole [(dV/VdP) ed, (dS/SdP) ed] In AP group, global diastolic (prolongation of T, decrease of nPFR) and systolic (decrease of EF,MNSER and nPER) function were simultaneously impaired, and regional diastolic (decrease of nPFR and RFF) and systolic decrease of EF and nPER) function were also impaired in the affected region supplied by LAD. While the rapid filling was impaired, nPAFR was maintained and AFF increased in the affected region of AP group. Furthermore. nPFR had a significant inverse correlation (r=-0.57,p<0.01) with AFF in anterior region. In the affected region oi AP group, (dS/SdP) ed tended to increase. Thus, we concluded that patients with isolated LAD disease had a simultaneous impairment of LV systolic anddiastolic function. Although the rapid filling was impaired, the passive filling during atrial contraction was preserved in the affected region of AP group.

Effort angina pectoris

LV regional diastolic function

Cine-ventriculography