土生 裕史, 森下 昌亮, 内藤 武夫, 平野 豊, 小川 巌, 石田 典裕, 加藤 久晴, 石川 欽司, 香取 瞭

Hirofumi HABU, Masataka MORISHITA, Takeo NAITO, Yutaka HIRANO, Iwao OGAWA, Norihiro ISHIDA, Hisaharu KATO, Kinji ISHIKAWA, Ryo KATORI

近幾大学医学部第一内科

The First Department of Medicine, Kinki University School of Medicine

キーワード : percutaneous transluminal coronary angioplasty, left ventricular filling, left ventricular diastolic function, pulsed doppler echocardiography, ischemic heart disease

To evaluate the serial changes of left ventricular diastolic function after successful elective percutaneous transluminal coronary angioplasty (PTCA) in coronary artery disease, mitral inflow velocity profiles were analyzed by pulsed doppler echocardiography and phonocardiography in 24 patients with ischemic heart disease (7 with and 17 without abnormal Q waves on electrocardiographic examination). Before PTCA, 19 of the 24 patients had positive treadmil tests and 19 of 20 patients were positive in T1–201 exercise myocardial scintigraphic studies. All 24 patients underwent successful angioplasty, when defined as residual stenosis <50%. Isovolumetric relaxation time (IRT), peak filling time (PFT), acceleration half time (AHT), deceleration half time (DHT), peak flow velocity in rapid filling (R), peak flow velocity during atrial systole (A), the A⁄R ratio and deceleration (DC) were measured before and 8 hours, 2 and 6 days after PTCA.
Eight hours after PTCA, left ventricular (LV) diastolic filling was not improved. Two days after PTCA LV diastolic filling was improved slightly, but there was no significant difference. Six days after PTCA, R increased (33.6±8.1 vs 40.7±7.6 cm⁄s p<0.001), A⁄R decreased (1.55±0.58 vs 1.21±0.36 p<0.01), IRT decreased (90±24 vs 77±16 ms p<0.05) and PFT decreased (189±19 vs 176±20 ms p<0.05). There were no significant changes in heart rate, AHT DHT and A. These results depend on improvements in LV diastolic filling in 17 patients without abnormal Q waves. In contrast, 7 patients with abnormal Q waves did not show any improvement in LV diastolic filling.
Thus it is suggested that LV diastolic function does not improve immediately after PTCA, but improves several days after PTCA in patients with myocardial ischemia on exertion without abnormal Q wave.