CHARACTERISTIC DIASTOLIC FILLING PATTERN IN PATIENTS WITH CORONARY-ARTERY DISEASE AND MODERATELY TO SEVERELY DEPRESSED LEFT-VENTRICULAR FUNCTION

To clarify the characteristics of left ventricular (LV) diastolic filling in patients with coronary artery disease (CAD) and moderately to severely depressed LV function, the following indices obtained by gated equilibrium radionuclide angiography were analyzed: (1) peak filling rate (PFR), (2) time-to-PFR, and (3) the first-third filling fraction. These parameters were compared with the data obtained by cardiac catheterization and myocardial scintigraphy. Sixty-five patients with CAD were divided into three groups: angina pectoris (Group 1), old myocardial infarction with 50% or more ejection fractions (EF) (Group 2), and with less than 50% EF (Group 3). Thirteen subjects without evidence of CAD were selected as controls. PFR decreased with the severity of LV dysfunction. Time to PFR was significantly prolonged in Groups 1 and 2, but was significantly shortened in Group 3 compared with normal controls. The first-third filling fraction in Group 3 was significantly lower than those of normal controls and Groups 1 and 2. The minimal LV pressure (LVP(min)) of Group 3 was significantly elevated compared with those of normal controls and Groups 1 and 2. LVP(min) was negatively but well correlated (r = -0.82; p < 0.01) with the time to PFR in Group 3. LVP(min) was positively well correlated (r = 0.72; p < 0.01) with the perfusion defect size by thallium-201 myocardial scintigraphy in patients with old myocardial infarctions. The results indicate that the shortened time to PFR was a specific LV filling pattern in CAD patients with moderately to severely depressed LV function. The shortening of the time to PFR seems to result from the reduction of LV active suction, indicated by the high LVP(min) associated with advanced myocardial damage.