Transesophageal echocardiographic assessment of systolic and diastolic dysfunction during percutaneous transluminal coronary angioplasty.

Left ventricular short-axis cross-sections at the level of the papillary muscles and transmitral flow were obtained with transesophageal echocardiography during percutaneous transluminal coronary angioplasty (PTCA) in 15 patients who had received anesthesia and who all demonstrated new areas of or more severe wall motion abnormality 10.2 +/- 4.3 seconds after initiation of balloon inflation. Both systolic (percentage area reduction and ejection fraction of the ischemic segment) and diastolic (early to atrial peak flow ratio and time velocity integral) function parameters and end-systolic wall stress changed significantly during PTCA. These changes were most profound during PTCA of the left anterior descending artery than they were during PTCA of the right coronary artery. Systolic and diastolic dysfunction are therefore invariably linked during transient ischemia, and PTCA of the left anterior descending artery consistently produced more profound dysfunction.