| Abstract: | Assessment of transmitral flow by Doppler echocardiography allows measurement of changes in left ventricular filling patterns in patients with cardiac disease. Typically a decrease in early diastolic flow velocity and increase in late diastolic flow velocity is found in various cardiac diseases. In order to assess the influence of overt heart failure on transmitral velocity profiles these were measured in 20 patients with a history of myocardial infarction and in 10 normal controls (group I). Of those patients with coronary heart disease 10 patients were in overt heart failure according to clinical and radiological criteria (group II); another 10 patients were compensated after treatment for heart failure (group III). In decompensated group II early diastolic flow velocity (E) was 91.2 cm/s and higher than 67.9 cm/s in group III (p less than 0.05) compared to 68.8 cm/s in the control group. In contrast late diastolic flow (A) at the time of atrial contraction was 41.2 cm/s in group II, 81.3 cm/s in group III, and 65.0 cm/s in group I (p less than 0.05). The ratio between early and late diastolic flow velocities (E/A) was 2.58 in group II, 0.87 in group III, and 1.06 in group I (p less than 0.05). Deceleration halftime was significantly shorter in group II as compared to the other two groups (p less than 0.05). These results can be interpreted as masking of the pathological flow patterns of the underlying heart disease (E/A ratio) by elevated left atrial filling pressure that leads to inversion of the pathologically altered velocity profiles of the underlying heart disease. These results might gain practical value for the care of patients in congestive heart failure if follow-up studies should demonstrate conversion of the flow pattern of group II to that of group III under treatment. |
