IMPAIRED RELAXATION PROFILE DOES NOT DIRECTLY IMPAIR THE PROXIMAL CORONARY FLOW: INSIGHTS FROM TRANSESOPHAGEAL DOPPLER ECHOCARDIOGRAPHY Jaroslaw D Kasprzak, Jarosław Drożdż, Jan Z. Peruga, Michał Plewka, Michał Ciesielczyk, Karina Wierzbowska, Tomasz Rechcinski, Michał Borkowski, Maria Krzemińska-Pakuła Akademia Medyczna w Łodzi, Łódź
Purpose: Pure abnormal relaxation (AR) profile is a widespread nonspecific marker of myocardial abnormalities but its pathogenetic implications are unknown. Using transesophageal Doppler echocardiography, a noninvasive method allowing the in vivo studies of human proximal coronary flow, we designed a study to assess whether the abnormal myocardial relaxation (mitral inflow E/A ratio<1.0) affects the proximal coronary flow. Methods: Proximal coronary flow was studied in the group of 38 patients with angiographically confirmed normal coronary arteries pulsed wave spectral Doppler. As judged from mitral inflow analysis, 15 patients had AR and 23 were used as controls (CO). Results: AR (E/A=0.70±0.18) group was similar to CO (E/A=1.42±0.43) except for (borderline significant) thicker left ventricular wall (11.2 vs 9.8mm). Reliable Doppler recordings of peak velocities, VTIs, acceleration and volumetric flow were available in 71%, 92%, 58% and 87% of patients for RCA, LMCA, CX and LAD, respectively. Quantitative Doppler parameters were similar in AR and CO groups for all arteries. In multivariate analysis, E/A was, surprisingly, inversely related to LMCA flow and peak diastolic velocity (p=0.039, p=0.02), CX diastolic flow VTI (univariate r=-0.44, p=0.04) and LAD diastolic VTI and peak velocity (multivariate p=0.002, p=0.045). Conclusions: Pure abnormal relaxation does not directly affect the proximal coronary flow, neither in the aspect of maximal flow velocities nor their timing. The finding of weak negative correlation of E/A ratio and diastolic flow velocity requires further investigation. The detection of relationships with other factors increasing diastolic flow might be addressed in a larger study.