Reversible diastolic dysfunction after successful coronary artery bypass surgery. Assessment by transesophageal Doppler echocardiography

Abstract

To assess the potential effects of coronary artery bypass surgery on left ventricular diastolic filling, 12 patients, aged 65 +/- 11 years, were studied by serial transesophageal Doppler echocardiograms. Doppler measures of mitral inflow velocity were made before, immediately after, 4 h after, and 20 h after cardiopulmonary bypass (CPB). Left atrial pressure was directly measured and controlled at 10 +/- 2 mm Hg for each study period. Mitral maximal early inflow velocity (E)/maximal atrial velocity (A) ratios and atrial filling fractions were calculated as indexes of diastolic function from maximal E and A velocities and their time velocity integrals, respectively. Data sets were available for serial comparison in 11 patients and were also compared with an age-matched control group of normal values. The results of E/A ratios were as follows: control group--1.4 +/- 0.2; before CPB--1.7 +/- 0.6; immediately after CPB--1.0 +/- 0.2 (p < 0.05 vs control group, before CPB, and 20 h after CPB values); 4 h after CPB--0.8 +/- 0.2 (p < 0.05 vs control group, before CPB, and 20 h after CPB values); and 20 h after CPB--1.3 +/- 0.4. Atrial filling fractions were as follows: control group--0.29 +/- 0.05; before CPB--0.25 +/- 0.06; immediately after CPB--0.43 +/- 0.07 (p < 0.05 vs control group, before CPB, and 20 h after CPB values); 4 h after CPB, 0.46 +/- 0.07 (p < 0.05 vs control group, before CPB, and 20 h after CPB values); and 20 h after CPB--0.35 +/- 0.06. Alterations in Doppler indexes of left ventricular filling occurred immediately after CPB and persisted 4 h after CPB. These indexes returned to baseline values by 20 h after CPB. This suggests reversible diastolic dysfunction in patients after coronary artery bypass surgery.