[Evaluation of left ventricular filling dynamics by pulsed Doppler echocardiography during afterload stress in ischemic heart disease using angiotensin II infusion].

To evaluate cardiac reserve in ischemic heart disease, we simultaneously investigated left ventricular filling parameters using pulsed Doppler echocardiography (PDE) and catheter-obtained hemodynamics before and during afterload stress (angiotensin II test) in 14 patients with ischemic heart disease. The patients were divided into two groups according to their left ventricular function, i.e., mean left ventricular ejection fraction (mLVEF): Group I (n = 7, mLVEF = 65%) and Group II (n = 7, mLVEF = 43%). The peak velocity of rapid filling (R), the peak velocity of atrial contraction (A), the ratio of the two peak velocities (A/R), flow velocity integrals of the rapid filling phase (IR) and atrial contraction phase (IA) were obtained by PDE. Results were as follows: 1. During afterload stress, blood pressure, pulmonary artery wedge pressure, and left ventricular end-diastolic pressures (LVEDP) were elevated in both groups (p less than 0.01). The stroke work index (SWI) increased (p less than 0.01) and the time constant of left ventricular isovolumic pressure decay (T) was unchanged in Group I. SWI did not increase and T was prolonged in Group II (p less than 0.05). delta SWI/delta LVEDP, the ratio of the SWI change to the LVEDP change, during afterload stress was larger in Group I than in Group II (p less than 0.02). 2. Before the infusion of angiotensin II, R and IR were larger in Group I than in Group II. The A/R in Group I was less than that in Group II (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)