Document Detail


Effect of early postoperative volume loading on left ventricular systolic function (including left ventricular ejection fraction determined by myocardial marker) after myocardial revascularization.
MedLine Citation:
PMID:  3896554     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The effects of early volume loading in terms of isovolumetric-phase and ejection-phase indexes of left ventricular systolic function were studied in 12 patients 5 hr after myocardial revascularization, with myocardial markers used to measure left ventricular volume directly and with simultaneous transmural left ventricular pressure measurements by micromanometers. Volume loading (increasing transmural left ventricular end-diastolic pressure from 11 +/- 4 to 15 +/- 5 mm Hg) induced a significant 14% increase in left ventricular end-diastolic volume index (LVEDVI), which was associated (as expected) with significant (p less than .005) augmentation of stroke work (+26%), left ventricular pressure-volume loop area (+35%), and stroke volume index (+22%) and with increments in left ventricular dP/dt and mean velocity of circumferential fiber shortening despite a simultaneous increase in left ventricular afterload. In contrast to previous radionuclide studies, however, left ventricular ejection fraction increased significantly (+9%) and the left ventricular end-systolic pressure-volume ratio did not fall. The relative change in ejection fraction was directly proportional to the increment in LVEDVI (r = .54, p = .03) and inversely related to the change in left ventricular end-systolic volume index (r = -.71, p = .0005). Patients who demonstrated a small or no increase in ejection fraction generally had a larger simultaneous increase in afterload, but one patient exhibited exhaustion of preload reserve. Ejection fraction, as an ejection-phase index of left ventricular performance, is highly dependent on afterload; therefore, interpretation of postoperative changes in ejection fraction must be undertaken only with strict caution.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
D C Miller; G T Daughters; G C Derby; R S Mitchell; N B Ingels; E B Stinson; E L Alderman
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  72     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1985 Sep 
Date Detail:
Created Date:  1985-10-03     Completed Date:  1985-10-03     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  II207-15     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Cardiac Output*
Cardiac Volume*
Cardiopulmonary Bypass
Catheterization
Female
Humans
Indicator Dilution Techniques
Male
Manometry
Middle Aged
Myocardial Contraction*
Myocardial Revascularization* / instrumentation,  methods
Postoperative Period
Pressure
Stroke Volume*
Systole*
Ventricular Function
Grant Support
ID/Acronym/Agency:
5 R01 HL 29589/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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