The Most Feasible Doppler Left Ventricular Diastolic function Measurements in the Elderly with 3 Vessel Coronary Artery Disease

Shin, Yung Woo

Abstract

Background: Normal aging causes a decrease in left ventricular diastolic function and so it expected to be a limitation in the diagnosis of ischemia-related impaired diastolic function in the elderly. This study was designed to find out the feasibility of the assessment at the left ventricular diastolic function and a useful diastolic index in the elderly with coronary artery disease.
Methods
The elderly patients (61~79 years old) who underwent coronary angiography for suspected coronary artery disease (CAD) were divided into 40 (23 women, 17 men) normal subjects and 42 (24 women, 18 men) patients with 3 vessel CAD, defined as 50% or more diameter stenosis of 3 major epicardial arteries were evaluated by conventional and tissue Doppler imaging. The following diastolic pulse wave and tissue Doppler imaging parameters were obtained: The peak early mitral inflow velocity (E), the peak late mitral inflow velocity (A), the ratio of E/A, the deceleration time of E (DT), the isovolumetric relaxation time (IRT), the peak early diastolic mitral annular velocity (Ea), the peak late diastolic mitral annular velocity (Aa), the ratio of Ea/Aa, and the ratio of E/Ea.
Results
The elderly patients with 3 vessel CAD had significantly higher E/Ea ratio, validated to be a good estimate of the left ventricular filling pressure, in the diastolic Doppler parameters when compared with normal controls (p=0.04), and could assess the left ventricular diastolic dysfunction. And E/Ea > 12 showed the case of 3 vessel CAD with higher frequency, especially in men with Ea < 5 cm/sec.
Conclusion
Left ventricular diastolic dysfunction at rest can be identified in the patients with 3 vessel CAD as compared with normal control in the elderly. The E/Ea ratio in the most useful diastolic index in the such cases.