Transmitral flow velocities and times during stress transthoracic echocardiography in patients with myocardial ischaemia

Twenty-nine men with chronic stable angina pectoris were investigatedusing stress electrocardiography (ECG) and stress transthoracicechocardiography by means of transoesophageal stimulation ofthe left atrium. At rest and after each stimulated frequency,ECG and 2-dimensional echocardiography combined with Dopplerwere performed simultaneously. Fourteen patients without ischaemiaat stress ECG and two patients who were subjected only to twodifferent frequencies of stimulation were excluded from ourstudy. Thirteen patients with ischaemic electrocardiographicresponse at stress, who were subjected to at least three stimulatedfrequencies, were evaluated. Their deceleration time of earlytransmitral filling was prolonged from 171±15.4 ms to178.1±14.4 ms (P = ns) after the first stimulated frequency,to 172.8±15.1 ms after the second stimulated frequency(P = ns) and was shortened to 143.6±7.9 ms (P<0.05)after the fastest stimulated frequency. The ratio of peak transmitralflow velocity in early diastole (E) to that during atrial contraction(A) decreased from 0.93±0.07 at rest to 0.85±0.07(P<0.05) after the first stimulated frequency, to 0.87±0.07(P=ns) after the second stimulated frequency and increased to1.13±0.08 (P<0.05) after the fastest stimulated frequency. In patients with angina pectoris and myocardial ischaemia, thechanges in the E/A ratio and deceleration time during stressare not linear and their direction depends on the moment oftheir evaluation. Their use for the quantitative evaluationof the diastolic function of the left ventricle is problematic.