Detection of early abnormalities of left ventricular function by hemodynamic, echo-tissue Doppler imaging, and mitral Doppler flow techniques in patients with coronary artery disease and normal ejection fraction

We have investigated the possibility of detecting early abnormalities of le ft ventricular function at the initial phase of ischemic cardiomyopathy. Si xteen normotensive patients with coronary artery disease and normal left ve ntricular ejection fraction and 6 control patients were studied by invasive hemodynamic techniques in combination with transmitral Doppler flow or wit h echo-tissue Doppler imaging. The extent of the percentage of left ventric ular longitudinal shortening and the systolic peak velocity at echo-tissue Doppler were significantly higher in the control patients than in patients with ischemic cardiomyopathy (P < .01). Left ventricular end-diastolic pres sure was higher (P < .05), whereas mean values of isovolumic contraction an d relaxation indexes (dP/dt/P: P < .05; +dP/dt: P < .05; -dP/dt: P < .01) w ere lower in patients with ischemic cardiomyopathy. Tau was significantly l onger in ischemic patients (42.7 +/- 8.8 versus 34.5 +/- 3.7 ins, P < .05). In the control patients, the aortic valve closure to peak E interval by tr ansmitral Doppler How was significantly longer than that measured by echo-t issue Doppler (P < .001), whereas in patients with ischemic cardiomyopathy, this interval difference was still present and significantly shorter (P < .05). In patients with coronary artery disease and normal ejection fraction , minor and early abnormalities of left ventricular function related to iso volumic contraction and relaxation as well as to longitudinal shortening co uld be detected. in addition, a suction-like effect, detected during early filling evaluation with echo-tissue Doppler, is significantly decreased but not abolished during the early stages of coronary artery disease.