DIASTOLIC FLOW PATTERNS OF THE LEFT-VENTR ICLE AFTER MYOCARDIAL-INFARCTION

The diastolic function of the left ventricle was investigated in 12 no rmal young volunteers, 10 older volunteers, 10 patients without eviden ce of coronary artery disease, 26 patients with inferior wall and 19 p atients with anterior wall infarction at eight locations of the total circumference of the left ventricle using pulsed wave Doppler. The rat io of early diastolic inflow (Vmax E) to the maximal velocity of atria l contraction (Vmax A) was determined. Furthermore, the delay between the end of electrical diastole until the end of the A-wave of the puls ed Doppler was measured. The results were compared with a clinically u sed marker of myocardial ischemia, treadmill exercise testing. The E/A ratio was 2.03 +/- 0.51 in normal volunteers, 1.1 6 +/- 0.41 in older volunteers, 1.41 +/- 0.59 in patients without evidence for coronary a rtery disease, 1.28 +/- 1.13 in patients with inferior and 1.08 +/- 0. 41 in patients with anterior wall infarction (p = 0.020 ANOVA). The di astolic delay at the apex was 47.3 +/- 8.9 ms in normal volunteers, 78 .3 +/- 8.3 ms in older volunteers, 79.1 +/- 13.7 ms in patients withou t coronary artery disease, 109.1 +/- 12 ms in patients with inferior a nd 169.5 +/- 18.8 ms in patients with anterior wall infarction (p = 0. 000 ANOVA). There was a correlation between the latter parameter of de lay and the amount of pathological wall segments at wall motion analys is (r = 0.61, p = 0.007). In two patients with anterior myocardial inf arction (11 %) with significant diastolic delay intraventricular throm bi developed consecutively. There was also a positive correlation betw een the height of the A-wave and a positive treadmill testing (p = 0.0 41 by Chi-square test). Conclusion: The diastolic function of the left ventricle, although influenced in contradictory ways by many factors, is suited to differentiate between infarction and non-infarction and between infarct locations.