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Titolo:
Improvement of afterload mismatch of left atrial booster pump function with positive inotropic agent
Autore:
Sakai, H; Kunichika, H; Murata, K; Seki, K; Katayama, K; Hiro, T; Miura, T; Matsuzaki, M;
Indirizzi:
Yamaguchi Univ, Sch Med, Dept Internal Med 2, Yamaguchi 7558505, Japan Yamaguchi Univ Yamaguchi Japan 7558505 l Med 2, Yamaguchi 7558505, Japan
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
fascicolo: 1, volume: 37, anno: 2001,
pagine: 270 - 277
SICI:
0735-1097(200101)37:1<270:IOAMOL>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
DIASTOLIC FUNCTION; LEFT-VENTRICLE; HEART-FAILURE; ACUTE DOPPLER; CATHETERIZATION; DOBUTAMINE; PRESSURE; CARDIOMYOPATHY; RELAXATION; STIFFNESS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
26
Recensione:
Indirizzi per estratti:
Indirizzo: Matsuzaki, M Yamaguchi Univ, Sch Med, Dept Internal Med 2, 1-1-1 Minamikogushi, Yamaguchi 7558505, Japan Yamaguchi Univ 1-1-1 Minamikogushi Yamaguchi Japan 7558505 n
Citazione:
H. Sakai et al., "Improvement of afterload mismatch of left atrial booster pump function with positive inotropic agent", J AM COL C, 37(1), 2001, pp. 270-277

Abstract

OBJECTIVES The objective of this study was to examine the hypothesis that a positive inotropic agent improves left ventricular (LV) filling during left atrial (LA) contraction in the presence of markedly elevated LV filling pressure. BACKGROUND In patients with old myocardial infarction (MI), an increase inthe operational LV chamber stiffness reduces LV filling during the LA contraction, resulting from an "afterload mismatch" of the LA booster pump function. METHODS We investigated the effect of dobutamine infusion (3 mug/kg/min) on the LA pump function in the presence of elevated LV filling pressure induced by aortic constriction (Aoc) during acute MI in 10 dogs. Transmitral flow velocity was determined by transesophageal echocardiography, LV pressureby a micromanometer and LV volume by a conductance catheter. We measured the early (E) and late (A) diastolic peak transmitral flow velocities (cm/s)and LV chamber stiffness (DeltaP/DeltaV: mm Hg/ml; where DeltaP is developed pressure and DeltaV is the absolute filling volume during LA contraction). RESULTS When the DeltaP/DeltaV was increased by Aoc during MI (from 1.1 +/- 0.8 to 3.1 +/- 2.6 mm Hg/ml, p < 0.01), A decreased significantly (from 30 +/- 5 to 22 +/- 8 cm/s, p < 0.01), and the ratio off to A increased (from1.0 +/- 0.3 to 1.4 +/- 0.8, P < 0.05) compared with MI without Aoc, showing the pseudonormal transmitral flow pattern, the so called "LA afterload mismatch. "CONCLUSIONS Dobutamine under this condition significantly reduced the <Delta>P/DeltaV (to 1.7 +/- 1.2 mm Hg/ml, p < 0.05), resulting in an increase in A (to 31 +/- 8 cm/s, p < 0.01) and a decrease in E/A (to 1.0 +/- 0.3, p <0.05), and the transmitral flow became a prolonged relaxation pattern as in MI without Aoc in all dogs. There was an inverse correlation between the <Delta>P/DeltaV and the time-velocity integral of A (r = -0.70, p < 0.01). Dobutamine improved the afterload mismatch of the LA booster pump function. This effect may have been due to the reduction in LV operational chamber stiffness, resulting in an increase in the LA forward ejection into the LV. (J Am Cell Cardiol 2001;37:270-7) (C) 2001 by the American College of Cardiology.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/07/20 alle ore 01:11:04