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We analyzed transmitral flow using pulsed Doppler echocardiography during anginal attack provoked by atrial pacing in 11 patients with coronary artery disease (CAD). Left ventricular (LV) filling period was divided into 4 time intervals (Tr1: the time interval to peak velocity of rapid filling (peak R), Tr2: the time interval from peak R to the end of rapid filling, Ts: the time interval of slow filling, Ta: the time interval of atrial contraction). The velocity in each interval was integrated by planimeter as IR1, IR2, IS or IA which indicates relative filling volume in each interval. During angina, IR1 was unchanged due to prolongation of Tr1 (82 +/- 21 to 102 +/- 23 msec, p less than 0.02), despite a decrease in peak R (54 +/- 11 to 43 +/- 11 cm/sec, p less than 0.005), while IR2 decreased (5.8 +/- 1.9 to 4.3 +/- 1.4 cm, p less than 0.005) and IA increased (6.7 +/- 1.4 to 7.3 +/- 1.3 cm, p less than 0.005). In conclusion, these results suggested that in acute myocardial ischemia in CAD a decrease in transmitral flow from the time of peak R to the end of rapid filling (IR2) reflected the impairment of the LV rapid filling, which was incompletely compensated by an increase in atrial contraction.

Pulsed doppler echocardiographic assement of transmitral flow in pacing-induced angina pectoris.