Prolongation of left atrial augmentation after handgrip stress in coronaryartery disease: Observation using pulsed Doppler flowmetry

Although alterations in left ventricular diastolic filling dynamics have be en observed during myocardial ischemia, few data exist regarding temporal c hanges in left ventricular filling during recovery. Therefore, the authors evaluated transmitral inflow pattern during and after handgrip exertion in coronary artery disease (CAD) by using Doppler echocardiography. The study population consisted of 18 normal (N) subjects and 47 patients with CAD. Of the CAD patients, 17 had coronary lesions associated with a limited area o f underperfused myocardium (seven with good collateral circulation and 10 w ith distal lesions) (MILD), 15 patients exhibited a proximal lesion in a si ngle vessel (SVD), and 15 patients had significant multivessel disease (MVD ). Transmitral inflow velocities were continuously recorded at baseline, du ring handgrip exercise (50% of maximal for 1 minute), and for 5 minutes of recovery. Mean blood pressure, heart rate, early diastolic (E) and late atr ial (A) inflow velocities, A/E ratio, and percent changes in E, A, and A/E from baseline were measured. In N and MILD, respectively, left ventricular inflow pattern returned to ba seline at 3 minutes after handgrip (%E: 0.7 +/-7.6%, 6.4 +/-13.7%; %A: -0.2 +/-7.9%, 3.1 +/-6.5%; %A/E: -0.1 +/-9.7%, -1.7 +/-12.9%). In SVD and MVD, respectively, change in left ventricular inflow pattern was continued at 3 minutes after handgrip (%E: 7.2 +/-9.4%, -4.3 +/-17.2%, %A: 15.4 +/-11.7%, 20.4 +/-14.6%, %A/E: 7.9 +/-10.0%, 29.2 +/-25.6%). Increases in A and A/E i n SVD and MVD were significantly higher than in N and MILD. Impaired left ventricular inflow pattern was observed at 3 minutes after ha ndgrip in CAD, which may be reflected from prolonged impairment of diastoli c function produced by ischemia. Therefore, temporal observation of left ve ntricular inflow pattern using the handgrip stress Doppler method may be us eful for detection or follow-up of CAD.