Özet:

Objective: Diastolic dysfunction of the left ventricle (LV) appears to be the earliest manifestation of myocardial ischemia. Experimental and clinical studies have shown that both early and late improvements of diastolic function occur after percutaneous transluminal coronary angioplasty (PTCA). Because of the limited utility of transmitral flow profile in the evaluation of the LV diastolic function, recently, assessment of myocardial velocities by Doppler tissue imaging is gaining importance. The aim of this study was to determine the utility of pulsed wave tissue Doppler (PWTD) pattern from the mitral and tricuspid annulus motion in the evaluation of early alterations of the LV diastolic function after revascularization with PTCA in patients with coronary artery disease. Methods: Pulsed wave tissue Doppler in combination with conventional pulsed-Doppler indices were used to evaluate LV diastolic function before and 24 hours after PTCA. Examinations were performed on 31 patients with chronic ischemic heart disease underwent elective first PTCA. As conventional Doppler indices, early diastolic mitral velocity (e), and its deceleration time (Edt), isovolumic relaxation time (IVRT), late diastolic mitral velocity (a) were measured. Using 2-dimensional echocardiography four chamber apical window, mitral annulus septal and lateral site and tricuspid annulus lateral site were viewed, and PWTD velocity profile were used to calculate; early diastolic maximum velocity and time, late diastolic maximum velocitya and time, systolic maximum velocity and time, IVRT and isovolumic contraction time (IVCT) from each site. Results: After PTCA only 2 transmitral conventional pulsed-Doppler indices were changed significantly (IVRT; from 139.7± 22.2 msec to 120 ± 15.96 msec, p=0.0001; Edt; from 279±11 msec to 248±36 msec, p=0.005). However, PWTD (mitral annulus lateral site) analyses showed significant improvement in most of the diastolic parameters: e/a ratio - from 0.806±0.26 to 0.89±0.22, p=0.012; s wave - from 11.69±3.1 cm/sec to 13.2±3.6 cm/sec, p=0.03; IVRT - from 130±37 msec to 108±29 msec, p=0,0001; IVCT - from 84.1±19.2 msec to 75.6±12.2 msec, p=0.02. Similar significant changes were also observed in the PWTD diastolic parameters of both the mitral annulus septal and tricuspit annulus sites. Peak systolic velocities that reflect the LV systolic functions, of three annular sites significantly improved early after PTCA, however ejection fraction was not changed as much as tissue Doppler parameters (s maximum velocity before PTCA: 11.7±3.1 cm/sec versus 13.2±3.6 cm/sec after PTCA, p=0.03). Conclusion: Tissue Doppler indices of the mitral annulus reflecting both the diastolic and systolic functions, improve early after successful PTCA in patients with coronary artery disease.

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