TRANSMITRAL DOPPLER ASSESSMENT OF LEFT-VENTRICULAR DIASTOLIC FUNCTIONDURING CORONARY-ARTERY BYPASS-SURGERY

Objective: To evaluate which Doppler transmitral velocity indices of l eft ventricular diastolic function change with alteration of left vent ricular filling pressure. Methods: Twenty-two patients undergoing coro nary artery bypass surgery. The effect of fluid loading on indices der ived from the transmitral Doppler waveform, recorded by a trans-oesoph ageal echocardiography, was evaluated using a generalised linear stati stical model. Results: E-wave maximum velocity, E-wave acceleration ti me and slope, E-wave deceleration slope, A-wave maximum velocity and E /A wave maximum velocity ratio showed significant changes after altera tions in left ventricular filling pressure. E-wave deceleration time a nd E-wave maximum velocity/time velocity integral showed no significan t change after fluid loading. Conclusion: Several commonly used Dopple r derived indices of left ventricular diastolic function are significa ntly affected by changes in filling pressure of the left ventricle. Th is may limit the usefulness of the Doppler method for serial assessmen t of diastolic function when the left ventricular filling pressure has changed between assessments. Only the E-wave deceleration time did no t show significant changes and might be a useful Doppler index for the serial measurement of left ventricular compliance but this needs to b e confirmed with haemodynamic measurements.