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Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo, N-0027 Norway
Acute myocardial ischemia
has been associated with abnormal filling patterns in the left
ventricular (LV) apex. We hypothesized that this may in part be due to
postsystolic shortening of ischemic apical segments, which
leads to reversal of early diastolic apical flow. Fourteen open-chest
anesthetized dogs were instrumented with micromanometers in the LV apex
and left atrium and myocardial sonomicrometers in the anterior apical
LV wall. Intraventricular filling by color Doppler and wall motion by
strain Doppler echocardiography (SDE) were assessed from an apical
view. Measurements were taken before and after 5 min of left anterior
descending coronary artery (LAD) occlusion. In four dogs, we measured
the pressure difference between the LV apex and outflow tract. At
baseline, peak early diastolic flow velocities in the distal one-third
of the LV were directed toward apex (9.2 ± 1.6 cm/s). After LAD
occlusion, the velocities reversed (
2.3 ± 0.4 cm/s,
P < 0.01), indicating that blood was ejected from the
apex toward the base during early filling. This interpretation was
confirmed by wall motion analysis, which showed postsystolic shortening
of apical myocardial segments. The postsystolic shortening represented
9.7 ± 1.7% (P < 0.01) and 14.2 ± 2.4%
(P < 0.01) of end-diastolic segment length by SDE and
sonomicrometry, respectively. Consistent with the velocity changes, we
found reversal of the early diastolic pressure gradient from the LV
apex to outflow tract. In the present model, acute LAD occlusion
resulted in reversal of early diastolic apical flow, and this was
attributed to postsystolic shortening of dyskinetic apical segments.
The clinical diagnostic importance of this finding remains to be determined.
strain-Doppler echocardiography; two-dimensional color Doppler; myocardial ischemia; diastolic filling
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