SUSTAINED REDUCTION IN VALVULAR REGURGITATION AND ATRIAL VOLUMES WITH TAILORED VASODILATOR THERAPY IN ADVANCED CONGESTIVE-HEART-FAILURE SECONDARY TO DILATED (ISCHEMIC OR IDIOPATHIC) CARDIOMYOPATHY

被引:56
作者
HAMILTON, MA
STEVENSON, LW
CHILD, JS
MORIGUCHI, JD
WALDEN, J
WOO, M
机构
[1] UNIV CALIF LOS ANGELES,SCH MED,DIV CARDIOL,47-123 CHS,10833 LECONTE AVE,LOS ANGELES,CA 90024
[2] AMER HEART ASSOC,LOS ANGELES,CA
关键词
D O I
10.1016/0002-9149(91)90556-Z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Afterload reduction therapy can acutely improve hemodynamic function in patients with advanced heart failure; however, it is unknown if initial reductions in mitral and tricuspid regurgitation and atrial volumes can be sustained with oral therapy. Atrial volumes and atrioventricular valve regurgitation were measured using 2-dimensional and Doppler echocardiography with color-flow imaging in 14 patients with dilated heart failure (ejection fraction 17 +/- 4%) before and after 3 +/- 1 days of intensive vasodilator and diuretic therapy tailored to hemodynamic goals. Echocardiography was repeated again after 6 +/- 2 months on oral vasodilators and a flexible diuretic regimen. Acute therapy reduced systemic vascular resistance from 1,760 +/- 460 to 1,010 +/- 310 dynes.s.cm-5, pulmonary artery wedge pressure from 30 +/- 5 to 17 +/- 4 mm Hg, and right atrial pressure from 13 +/- 5 to 7 +/- 3 mm Hg, and led to a 61% increase in stroke volume (from 36 + 10 to 58 +/- 14 ml) (p < 0.01). Mitral and tricuspid regurgitation, determined by color-flow fraction, initially decreased from 0.34 +/- 0.17 to 0.20 +/- 0.20 and from 0.33 +/- 0.15 tp 0.13 +/- 0.13, respectively (p < 0.001). This reduction was sustained at 6 months. Significant decreases occurred with acute therapy, with further reductions at 6 months in both mean left atrial volume (from 100 +/- 25 to 80 +/- 19 to 65 +/- 15 cm3) and right atrial volume (from 85 +/- 23 to 64 +/- 23 to 52 +/- 14 cm3) (p < 0.001). Echocardiographic estimate of mean pulmonary artery pressure decreased acutely (from 42 +/- 5 to 30 +/- 7 mm Hg, p < 0.001), then remained unchanged at follow-up. Congestive symptoms and signs were also markedly improved at 6 months (p < 0.05). In conjunction with clinical improvement in 6-month survivors with advanced heart failure, acute reductions in atrial volumes and atrioventricular valve regurgitation can be sustained on long-term oral vasodilators and diuretics.
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页码:259 / 263
页数:5
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