DYNAMIC MITRAL REGURGITATION - AN IMPORTANT DETERMINANT OF THE HEMODYNAMIC-RESPONSE TO LOAD ALTERATIONS AND INOTROPIC THERAPY IN SEVERE HEART-FAILURE
DYNAMIC MITRAL REGURGITATION - AN IMPORTANT DETERMINANT OF THE HEMODYNAMIC-RESPONSE TO LOAD ALTERATIONS AND INOTROPIC THERAPY IN SEVERE HEART-FAILURE
复制标题
DOI：
10.1161/01.cir.80.2.306
复制
发表时间：
1989-08-01
期刊：
影响因子：
37.8
通讯作者：
LEJEMTEL, TH
中科院分区：
文献类型：
--
作者：
KEREN, G;KATZ, S;LEJEMTEL, TH
本文应用多普勒超声心动图和右心导管对12例严重充血性心力衰竭患者进行等长收缩运动，并与多巴酚丁胺和硝酸甘油静脉给药进行对照。在等长收缩运动中，二尖瓣收缩容积从18 ± 1.5mm增加到10 ± 1.5mm。13到31 .+-. 17 ml（p < 0.01），而通过热稀释法和多普勒超声心动图测定的前向每搏输出量显著降低。在休息时，多巴酚丁胺减少二尖瓣返流体积从18 ±-。13到11 .+-. 10 ml（p < 0.05），而前向每搏输出量从46 . ±. 13到55 .+-. 15 ml（p < 0.05）。在等长收缩运动中，多巴酚丁胺倾向于减少二尖瓣反流容积（24 . ±. 12对31 +-。17 ml; NS）与对照运动相比。休息时，硝酸甘油使二尖瓣反流量从18 ±-减少。13或11 .+-。11 ml（p < 0.05），而通过热稀释法和多普勒超声心动图测定的前向每搏输出量显著增加。同样地，在等长收缩运动中，硝酸甘油使二尖瓣反流容积从31 ± 1.5减少到31 ± 1.5。17到20 .+-. 14 ml（p < 0.05），同时显著增加前向每搏输出量。在对照休息时，12例患者的中位抗抑郁剂分数为24%。多巴酚丁胺和硝酸甘油均未显著改变6例静息二尖瓣返流分数低于中位数的患者在静息和等长运动时的前向搏出量和二尖瓣返流量。相比之下，多巴酚丁胺和硝酸甘油显着减少二尖瓣返流量和增加前向每搏输出量在休息和等长运动中的6例二尖瓣返流分数大于中位数。因此，严重充血性心力衰竭患者在等长运动期间观察到的前向每搏输出量下降与二尖瓣返流加重有很大关系。功能性二尖瓣返流的存在和严重程度似乎是这些患者多巴酚丁胺和硝酸甘油急性治疗的血流动力学反应的重要决定因素。
Cardiac performance and mitral regurigitation were measured by Doppler echocardiogrpahy and right heart catheterization in 12 patients with severe congestive heart failure who performed isometric exercise during control and intravenous administration of dobutamine and nitroglycerin. During isometric exercise, mitral regurgitant volume increased from 18 .+-. 13 to 31 .+-. 17 ml (p < 0.01), while forward stroke volume, by both thermodilution and Doppler echocardiography, substantially decreased. At rest, dobutamine decreased mitral regurgitant volume from 18 .+-. 13 to 11 .+-. 10 ml (p < 0.05), while forward stroke volume increased from 46 .+-. 13 to 55 .+-. 15 ml (p < 0.05). During isometric exercise, dobutamine tended to decrease mitral regurgitant volume (24 .+-. 12 vs. 31 .+-. 17 ml; NS) when compared with control exercise. At rest, nitroglycerin decreased mitral regurgitant volume from 18 .+-. 13 ot 11 .+-. 11 ml (p < 0.05), while forward stroke volume, by both thermodilution and Doppler echocardiography, substantially increased. Similarly, during isometric exercise, nitroglycerin decreased mitral regurgitant volume from 31 .+-. 17 to 20 .+-. 14 ml (p < 0.05), while significantly increasing forward stroke volume. At control rest, the median regurgitant fraction was 24% for the 12 patients. Neither dobutamine nor nitroglycerin changed significantly forward stroke and mitral regurgitant volumes at rest and during isometric exercise in the six patients with resting mitral regurgitant fraction below the median. In contrast, dobutamine and nitroglycerin significantly decreased mitral regurgitant volume and increased forward stroke volume both at rest and during isometric exercise in the six patients with mitral regurgitant fraction greater than the median. Thus, aggravation of mitral regurgitation contributes substantially to the fall in forward stroke volume noted during isometric exercise in patients with severe congestive heart failure. The presence and severity of funcional mitral regurgitation appears to be an important determinant of the hemodynamic response to acute therapy with dobutamine and nitroglycerin in these patients.