Improved left ventricular diastolic filling in patients with coronary artery disease after percutaneous transluminal coronary angioplasty

Left ventricular (LV) diastolic filling is abnormal at rest in many patients with coronary artery disease (CAD), even in the presence of normal resting LF systolic function. To determine the effects of improved myocardial perfusion on impaired LV diastolic filling, we studied 25 patients with one-vessel CAD by high-temporal-resolution radionuclide angiography before and after percutaneous transluminal coronary angioplasty (PTCA). No patient had ECG evidence of previous myocardial infarction. Despite normal regional and global LV systolic function at rest in all patients, LV diastolic filling was abnormal (peak LV filling rate [PFR] < 2.5 end-diastolic volumes (EDV)/sec or time to PFR > 180 msec) in 17 of 25 patients. Twenty-three patients had abnormal LV systolic function during exercise. After successful PTCA, LV ejection fraction and heart rate at rest were unchanged, but LV ejection fraction during exercise increased, from 52 ± 8% (± SD) to 63 ± 5% (p < 0.001). LV diastolic filling at rest improved: PFR increased from 2.3 ± 0.6 to 2.8 ± 0.5 EDV/sec (p < 0.001) and time to PFR decreased from 181 ± 22 to 160 ± 18 msec (p < 0.001). Thus, a reduction in exercise-induced LV systolic dysfunction after PCTA, reflecting a reduction in reversible ischemia, was associated with improved LV diastolic filling at rest. These data suggest that in many CAD patients with normal resting LV systolic function and without previous infarction, abnormalities of resting LV diastolic filling are not fixed, but appear to be reversible manifestations of impaired coronary flow.