Role of transmittal blood flow velocity by doppler echocardiography in the evaluation of coronary artery disease

Abstract

To determine the relation between presence and severity of coronary artery disease and diastolic filling abnormalities by Doppler echocardiography, recordings of transmitral inflow velocity were made at rest in 90 patients with coronary artery disease and 28 normals. At the time of the Doppler examination, 81 patients with coronary artery disease (90%) and 10 normals (36%) were treated with antianginal medications. No difference was found in the ratio between early (E) and late (A) diastolic filling velocity (E/A ratio) when comparing patients with greater than 70% obstruction of at least one coronary artery to age-matched normals, regardless of the presence or absence of wall motion abnormalities. The E/A ratio was 1.3 +/- 0.46 in coronary patients with normal wall motion, 1.2 +/- 0.47 in coronary patients with abnormal wall motion, and 1.3 +/- 0.53 in both samples of age-matched normals. Multivariate analysis of the relation between E/A ratio and other variables showed that heart rate (F = 24.46, p less than 0.00001) and age (F = 19.51, p less than 0.00001) were significant independent determinants of the E/A ratio, while the presence or severity of coronary artery disease, the presence of hypertension, the magnitude of wall motion abnormalities, and end-diastolic dimension by echocardiography were not. These data suggest that transmitral inflow velocity recordings by Doppler have limited value for the recognition of coronary artery disease, since the E/A ratio is profoundly influenced by other factors, such as heart rate and age.

Age-related hemodynamic changes during diastole: a combined M-mode and Doppler echo study

“…In agreement with results obtained in smaller study groups [1,4,12] the A/E ratios of the peak flow velocities (PAV/PEV) and the velocity-time integrals (VTI-A/E), the atrial filling fraction (AFF), the E-wave deceleration time (DT) as well as the isovolumic relaxation period (IVRP) were significantly higher in older subjects (>40 years) as compared to younger ones (40 years) ( Table 2). In concordance with radionuclide findings [7] this corresponds to an increase of the relative share of atrial contraction to LV filling with increasing age.…”

“…In concordance with radionuclide findings [7] this corresponds to an increase of the relative share of atrial contraction to LV filling with increasing age. Furthermore the results of the present study reflect an impairment of the energy-consuming process of early diastolic relaxation [5] as it has been described for a variety of cardiac diseases, in particular for coronary artery disease [1,3,14] and hypertensive heart disease [6].…”

“…Together with the exclusion of subjects suffering from diabetes mellitus (silent myocardial ischemia) we could nevertheless minimize the probability of including individuals with coronary artery disease into the study. F u r t h e r m o r e even in coronary patients a positive correlation between age and atrial contribution to L V filling has been reported on [1].…”

“…In part these pathologic flow patterns occur even in the absence of impaired systolic function [11]. Only few data exist on the impact of aging on mitral flow as assessed by Doppler echocardiography, all referring to different sample volume locations [1,4,12].…”

“…The method has been validated in comparison with both cineangiographic [10] and radionuclide techniques [2]. Abnormal LV diastolic performance has been detected by means of pulsed Doppler echocardiography for a variety of diseases such as coronary artery disease [1,3,13] and hypertensive heart disease [6]. In part these pathologic flow patterns occur even in the absence of impaired systolic function [11].…”