Transesophageal echocardiography values for left ventricular end-diastolic area and pulmonary vein and mitral inflow Doppler velocities in patients undergoing coronary artery bypass graft surgery

Transesophageal echocardiographic area and Doppler flow velocity measurements: comparison with hemodynamic changes in coronary artery bypass surgery.

Aims To assess the effects of 6 months intervention with ramipril on resting and post exercise left ventricular function in patients with stable ischaemic heart disease and preserved left ventricular systolic function.

Methods and Results Patients (n=98, age 65±9 years, 37% women) were randomized to double-blind treatment with ramipril 5mg.day−1(n=32), ramipril 1·25mg.day−1(n=34), or placebo (n=32). Resting and post maximum exercise echocardiography/Doppler examinations were performed at baseline and after 6 months. Changes over 6 months in resting transmitral E-wave deceleration time (Edt) and Edt adjusted for heart rate (Edt/RR) differed between the ramipril 5mg, ramipril 1·25mg, and placebo groups: Edt 24±82, −1±69, and −29±64ms, respectively, P =0·012; Edt/RR 30±105, 2±61, and −28±69ms, respectively, P =0·015. Changes in the difference between resting and post exercise Edt/RR also varied between groups: −53±137, −28±118, and 35±101ms, respectively, P =0·029. No differences in E/A indices were noted. Resting atrioventricular plane displacement improved in the combined ramipril groups vs the placebo group: 0·2±0·8 vs −0·2±1·3mm, P <0·05.

Conclusion Six months ramipril treatment in patients with stable ischaemic heart disease and preserved left ventricular systolic function improved resting left ventricular function and reduced the exercise induced diastolic filling abnormalities usually seen in these patients.

/pdf/ace-inhibition-with-ramipril-improves-left-ventricular-3eaycnx8pn.pdf

ACE inhibition with ramipril improves left ventricular function at rest and post exercise in patients with stable ischaemic heart disease and preserved left ventricular systolic function.

OBJECTIVE To evaluate which Doppler transmitral velocity indices of left ventricular diastolic function change with alteration of left ventricular filling pressure. METHODS Twenty-two patients undergoing coronary artery bypass surgery. The effect of fluid loading on indices derived from the transmitral Doppler waveform, recorded by a trans-oesophageal echocardiography, was evaluated using a generalised linear statistical model. RESULTS E-wave maximum velocity, E-wave acceleration time and slope, E-wave deceleration slope, A-wave maximum velocity and E/A wave maximum velocity ratio showed significant changes after alterations in left ventricular filling pressure. E-wave deceleration time and E-wave maximum velocity/time velocity integral showed no significant change after fluid loading. CONCLUSION Several commonly used Doppler derived indices of left ventricular diastolic function are significantly affected by changes in filling pressure of the left ventricle. This may limit the usefulness of the Doppler method for serial assessment of diastolic function when the left ventricular filling pressure has changed between assessments. Only the E-wave deceleration time did not show significant changes and might be a useful Doppler index for the serial measurement of left ventricular compliance but this needs to be confirmed with haemodynamic measurements.

Transmitral Doppler assessment of left ventricular diastolic function during coronary artery bypass surgery.

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Transmitral Doppler assessment of left ventricular diastolic function during coronary artery bypass surgery.