A NEW SCORING SYSTEM, USING DOPPLER TRANSMITRAL DIASTOLIC MEASUREMENT, IDENTIFIES TRANSIENT MYOCARDIAL-ISCHEMIA

In patients with acute transient myocardial ischaemia, changes in left ventricular filling produce alterations in transmitral diastolic flow velocity and isovolumic relaxation time. In this study a scoring syst em derived from isovolumic relaxation time and indices from transmitra l flow velocity was used to evaluate perioperative transient myocardia l ischaemia. Fifty three patients with known coronary artery disease o r at risk were studied. Ischaemic events were assessed using Doppler t ransoesophageal echocardiography midoesophageal left ventricular four- chamber view planes. Diastolic Doppler ratios of peak early to atrial peak (E/A), deceleration time, deceleration rate and isovolumic relaxa tion time were scored using standard methods. An evaluation of peri-op erative ischaemic events could be important for patients with a non-is chaemic cause for abnormal segmental wall motion, as the use of a two- dimensional scoring system has limitations. Acute changes in the Doppl er ratio of peak early to atrial peak must be interpreted cautiously d uring surgery. Diastolic dysfunction commonly occurs during ischaemia and recognition of this may alter the approach to monitoring as well a s to treatment.