Isolated impairement of the regional filling of the left ventricle in the coronary patient with normal systolic function. A study by isotopic ventriculography during rest

: The aim of this study was to assess whether resting radionuclide angiography could detect isolated regional left ventricular filling abnormalities due to chronic ischemia. The authors studied global and regional (10 segments) variations of LV volume using an original computerised system in 29 patients with single vessel coronary artery disease and normal systolic function without any other known pathology which could have altered left ventricular filling. Purely diastolic regional wall abnormalities were detected in presumed ischemic territories in over 60% of patients. They were then observed mostly in early rather than late diastole and affected the chronological indices (time to 1/3 LV filling, or to peak early diastolic filling rate) more than those of velocity (peak E or A velocities) or volume (filling fraction at 1/3 and half-diastole or that due to atrial contraction). They suggested delayed relaxation in these regions. These segmental changes are associated with a significant increase in asynchronous filling as judged by the variation in the intervals to peak early diastolic filling (tE) (p less than 0.001) and to one third filling (T 1/3R) (p less than 0.02), in the absence of increased physiological asynchronous contraction. An inversed relationship was observed (p less than 0.01) between the global value of peak early diastolic velocity and the indices of early diastolic asynchronous filling tE (r = -0.48) and T1/3R (r = -0.54). As previously reported, these regional abnormalities are, however, generally too small to cause changes in global diastolic function.