| Right ventricular dysfunction during intensive pharmacologic unloading persists after mechanical unloading. | |
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MedLine Citation:
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PMID: 20206896 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Right ventricular (RV) dysfunction is associated with adverse outcomes in heart failure (HF). Mechanical unloading should be more effective than pharmacologic therapy to reduce RV afterload and improve RV function. We compared RV size and function after aggressive medical unloading therapy to that achieved in the same patients after 3 months of left ventricular assist device (LVAD) support. METHODS AND RESULTS: We studied 20 patients who underwent isolated LVAD placement (9 pulsatile and 11 axial flow). Echocardiograms were performed after inpatient optimization with diuretic and inotropic therapy and compared with studies done after 3 months of LVAD support. After medical optimization right atrial pressure was 11 +/- 5 mm Hg, mean pulmonary artery pressure 36 +/- 11 mm Hg, pulmonary capillary wedge pressure 23 +/- 9 mm Hg, and cardiac index 2.0 +/- 0.6 L.min.m(2). Preoperatively, RV dysfunction was moderate (2.6 +/- 0.9 on a 0 to 4 scale), RV diameter at the base was 3.1 +/- 0.6 cm, and mid-RV was 3.5 +/- 0.6 cm. After median LVAD support of 123 days (92 to 170), RV size and global RV dysfunction (2.6 +/- 0.9) failed to improve, despite reduced RV afterload. CONCLUSIONS: RV dysfunction seen on intensive medical therapy persisted after 3 months of LVAD unloading therapy. Selection of candidates for isolated LV support should anticipate persistence of RV dysfunction observed on inotropic therapy. |
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Authors:
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Maryse Palardy; Anju Nohria; Jose Rivero; Neal Lakdawala; Patricia Campbell; Mahoto Kato; Leslie M Griffin; Colleen M Smith; Gregory S Couper; Lynne W Stevenson; Michael M Givertz |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-12-11 |
Journal Detail:
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Title: Journal of cardiac failure Volume: 16 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-08 Completed Date: 2010-06-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 218-24 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Pressure Cardiotonic Agents / administration & dosage* Cohort Studies Combined Modality Therapy Diuretics / administration & dosage* Echocardiography, Doppler, Pulsed Female Follow-Up Studies Heart Function Tests Heart-Assist Devices* Hemodynamics / physiology Humans Male Middle Aged Probability Pulmonary Wedge Pressure Retrospective Studies Risk Assessment Severity of Illness Index Survival Rate Treatment Outcome Ventricular Dysfunction, Right / drug therapy*, mortality, surgery*, ultrasonography |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents; 0/Diuretics |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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