VARIABILITY OF CHANGES IN DOPPLER TRANSMITRAL FILLING PATTERN DURING STRESS ECHOCARDIOGRAPHY IN PATIENTS WITH STABLE ANGINA-PECTORIS

Stress electrocardiography and echocardiography using atrial pacing together with the right-sided heart catheterization were performed in 21 patients with stable angina pectoris. Peak velocity of transmitral flow in early diastole (E) and in atrial contraction (A), deceleration time of early filling, and pulmonary artery wedge pressure were measured simultaneously at rest and immediately after each pacing frequency. Patients were divided according to their stress pulmonary artery wedge pressure changes into Group A (14 patients with an increase in pulmonary artery wedge pressure greater than or equal to 3 mmHg during stress) and into Group B (6 patients with a change in pulmonary artery wedge pressure less than or equal to 2 mmHg during stress). One patient, T.L., with an increase in pulmonary artery wedge pressure greater than or equal to 5 mmHg after each pacing frequency was evaluated separately. In Group A patients, the non-linear course of the EIA ratio changes (from 0.78 +/- 0.06 to 0.66 +/- 0.05, P < 0.01; to 0.72 +/- 0.05, P = NS; and to 0.93 +/- 0.06, P < 0.01) and deceleration time changes (from 188.9 +/- 7.2 ms to 195.3 +/- 8.9 ms, P = NS; to 188.8 +/- 9.9 ms, P = NS; and to 154.2 +/- 6.7 ms, P < 0.01) was seen. In Group B patients, the EIA ratio gradually decreased during stress (from 0.82 +/- 0.07 to 0.77 +/- 0.07, P = NS; to 0.74 +/- 0.06, P = NS; and to 0.69;+/- 0.06, P < 0.05) and deceleration time insignificantly increased during stress (from 206.7 +/- 15.9 ms to 215.7 +/- 17.5 ms, to 217.8 +/- 15.9 ms, and to 216.3 +/- 15.7 ms; all P = N.S.), In patient T.L., the opposite course of changes in Doppler filling pattern compared with Group B patients was found (the EIA ratio fluently increased from 0.83 to 0.94, to 0.98, and to 1.71; deceleration time decreased from 178 ms to 152 ms, to 150 ms, and to 103 ms). Thus, the changes in the E/A ratio and deceleration time during pacing stress can be very varied, depending on the changes in filling pressure of the left ventricle. The use of these parameters for the non-invasive quantitative evaluation of the left ventricular diastolic function is problematic.