| Loss of Adrenergic Augmentation of Diastolic Intra-LV Pressure Difference in Patients With Diastolic Dysfunction: Evaluation by Color M-Mode Echocardiography. | |
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MedLine Citation:
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PMID: 22974796 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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OBJECTIVES: The aim of this study was to evaluate the hypothesis that the adrenergic response of the intraventricular pressure difference (IVPD) is reduced in patients with preserved ejection fraction (EF) and diastolic dysfunction (DD). BACKGROUND: In early diastole, there is a progressive IVPD extending from the left atrium (LA) to the left ventricular (LV) apex. In response to adrenergic stimulation, as occurs during exercise, the IVPD increases allowing rapid filling without an abnormal increase in LA pressure. Patients with heart failure with a reduced EF have impaired adrenergic augmentation of the IVPD. METHODS: We studied 166 consecutive patients undergoing dobutamine stress echocardiography who had no inducible ischemia and an EF ≥50%, of which 21 had normal diastolic function, 14 had impaired relaxation (grade 1), 80 had pseudonormal filling (grade 2), and 51 had restrictive filling (grade 3). Color M-mode Doppler (CMMD) images of mitral inflow were obtained at rest and during low (10 μg/kg/min) and peak (20 to 40 μg/kg/min) doses of dobutamine. The total IVPD from the LA to LV apex, LA to mid-LV, and mid-LV to the LV apex were calculated using the CMMD data to integrate the Euler equation. RESULTS: Total IVPD was not different between groups at rest. With dobutamine, the total IVPD increased by 2.20 ± 1.95 mm Hg in normal subjects and by only 0.73 ± 1.33 mm Hg, 1.84 ± 1.63 mm Hg, and 1.08 ± 1.57 mm Hg in patients with grades 1, 2, and 3 DD, respectively. This difference was due to a failure in augmentation of IVPD from the mid-LV to the LV apex, indicating reduced apical ventricular suction with DD, whereas the IVPD from the LA to the mid-LV responded similarly to dobutamine in normal subjects and those with DD. CONCLUSIONS: In patients with preserved EF, DD is associated with a reduced adrenergic augmentation of the IVPD from the mid-LV to the LV apex, reflecting less apical suction. |
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Authors:
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Takahiro Ohara; Cassie L Niebel; Kelley C Stewart; John J Charonko; Min Pu; Pavlos P Vlachos; William C Little |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: JACC. Cardiovascular imaging Volume: 5 ISSN: 1876-7591 ISO Abbreviation: JACC Cardiovasc Imaging Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-09-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101467978 Medline TA: JACC Cardiovasc Imaging Country: United States |
Other Details:
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Languages: eng Pagination: 861-70 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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