Abstract
In treating patients with acute hypertensive heart failure we often try preload-reduction therapy using diuretics or vasodilators, but this may frequently produce a considerable decrease in cardiac output, particularly in hypertensive patients with diastolic dysfunction. Therefore, it is important from the clinical standpoint to predict the change in cardiac output following preload-reduction therapy. The objective of this study was to assess whether the change in cardiac output in association with preload-reduction therapy is predictable before treatment by analysis of mitral flow velocity patterns in patients with hypertensive heart failure. Changes in left ventricular volumes and cardiac output in association with preload-reduction therapy and Doppler echocardiographic parameters of the mitral flow velocity pattern before treatment were studied in 18 patients with hypertensive heart failure. Cardiac output increased in six patients with systolic dysfunction (fractional shortening <25%). In the other 12 patients (those with normal systolic function), the changes in cardiac output were homogenous among the patients. In this subset there was a greater decrease in cardiac output in patients with a shorter deceleration time. Thus, analysis of deceleration time of the early diastolic filling wave before treatment may be useful in estimating the change in cardiac output following preload reduction in patients with hypertensive heart failure due to diastolic dysfunction.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Shepherd RFJ, Zachariah PK, Shub C. Hypertension and left ventricular diastolic function. Mayo Clin Proc 1989;64:1521-1532.
Stampfer M, Epstein SE, Beiser GD, Braunwald E. Hemodynamic effects of diuresis at rest and during intense upright exercise in patients with impaired cardiac function. Circulation 1968;37:900-911.
Carroll JD, Lang RM, Neumann AL, Borow KM, Rajfer SI. The differential effects of positive inotropic and vasodilator therapy on diastolic properties in patients with congestive cardiomyopathy. Circulation 1986;74:815-825.
Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988;12:426-440.
Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effects of different loading conditions. Circulation 1990;81:1488-1497.
Appleton CP, Gonzalez MS, Basnight MA, McArthur A, Zine T. Relationship of left ventricular pressure and pulmonary venous flow velocities: Importance of baseline mitral and pulmonary venous flow velocity patterns studied in lightly sedated dogs. J Am Soc Echocardiogr 1994;7:264-275.
Nagano R, Masuyama T, Lee JM, et al. Transthoracic Doppler assessment of pattern of left ventricular dysfunction in hypertensive heart disease: Combined analysis of mitral and pulmonary venous flow velocity patterns. J Am Soc Echocardiogr 1994;7:493-505.
Sahn DJ, DeMaria A, Kisslo J, Weyman AE (The Committee on M-mode Standardization of the American Society of Echocardiography). Recommendations regarding quantitation of M-mode echocardiography: Results of survey of echocardiographic measurements. Circulation 1978;58:1072-83.
Teichholtz LE, Krenlen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence and absence of of asynergy. Am J Cardiol 1976;37:7-11.
Litwin SE, Grossman W. Diastolic dysfunction as a cause of heart failure. J Am Coll Cardiol 1993;22(Suppl A):49A-55A.
Packer M. Abnormalities of diastolic function as a potential cause of exercise intolerance in chronic heart failure. Circulation 1990:81(Suppl III):III78-III86.
Little WC, Downes TR. Clinical evaluation of left ventricular diastolic performance. Progr Cardiovasc Dis 1990;32:273-290.
Thomas JD, Weyman AE. Echocardiographic Doppler evaluation of left ventricular diastolic function. Physics and physiology. Circulation 1991;84:977-990.
Gaasch WH, Levine HJ, Quinones MA, Alexander J. Left ventricular compliance: Mechanism and clinical implications. Am J Cardiol 1976;38:645-653.
Ludbrook PA, Byrne JD, McKnight RC. Influence of right ventricular hemodynamics on left ventricular diastolic pressure-volume relations in man. Circulation 1979;59:21-31.
Smith ER, Smiseth OA, Kingma I, Manyari D, Belenkie I, Tyberg JV. Mechanism of action of nitrates. Role of changes in venous capacitance and in the left ventricular diastolic pressure-volume relation. Am J Med 1984;76:14-21.
Tyberg JV, Misbach GA, Parmley WW, Glantz SA. Effects of the pericardium left ventricular performance. In: Baan J, Arntzenius AC, Yellin EL eds. Cardiac Dynamics. The Hague: Martinus Nijhoff, 1987:159-168.
Dauterman K, Pak P, Maughan WL, Kass DA. How much can LVEDP be reduced in humans without compromising preload volume and cardiac output? (abstrt). Circulation 1994;90(Supp I):I611.
Masuyama T, St. Goar FG, Alderman EL, Popp RL. Effects of nitroprusside on transmitral flow velocity patterns in extreme heart failure: A combined hemodynamic and Doppler echocardiographic study of varying loading conditions. J Am Coll Cardiol 1990;16:1175-1185.
Hatle LK, Appleton CP, Popp RL. Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography, Circulation 1989;79:357-370.
Pinamonti B, Lenarda AD, Sinagra G, Camerini F, The heart muscle disease study group. Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: Clinical, echocardiographic and hemodynamic correlations and prognostic implications. J Am Coll Cardiol 1993;22:808-815.
Appleton CP, Hatle LK, Popp RL. Demonstration of restrictive ventricular physiology by Doppler echocardiography. J Am Coll Cardiol 1988;11:757-768.
Ohno M, Cheng CP, Little WC. Mechanism of altered patterns of left ventricular filling during the development of congestive heart failure. Circulation 1994;89:2241-2250.
Klein AL, Hatle LK, Taliercio CP, et al. Prognostic significance of Doppler measures of diastolic function in cardiac amyloidosis. A Doppler echocardiography study. Circulation 1991;83:808-816.
Oh JK, Ding ZP, Gersh BJ, Bailey KR, Tajik AJ. Restrictive left ventricular diastolic filling identifies patients with heart failure after acute myocardial infarction. J Am Soc Echocardiogr 1992;5:497-503.
Thomas JD, Choong CYP, Flachskampf FA, Weyman AE. Analysis of the early transmittal Doppler velocity curve: Effect of primary physiologic changes and compensatory preload adjustment. J Am Coll Cardiol 1990;16:644-655.
Yamamoto K, Masuyama T, Tanouchi J, et al. Importance of left ventricular minimal pressure as a determinant of transmittal flow velocity pattern in the presence of left ventricular systolic dysfunction. J Am Coll Cardiol 1993;21:662-672.
Ludbrook PA, Byrne JD, Kurnic PB, McKnight RC. Influence of reduction of preload and afterload by nitroglycerin on left ventricular diastolic pressure-volume relations and relaxation in man. Circulation 1977;56:937-943.
Bonow RO, Bacharach SL, Green MV, et al. Impaired left ventricular diastolic filling in patients with coronary artery disease: Assessment with radionuclide angiography. Circulation 1981;64:315-323.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nagano, R., Masuyama, T., Lee, JM. et al. Prediction of the Changes in Cardiac Output in Association with Preload Reduction Therapy in Patients with Hypertensive Heart Failure. Cardiovasc Drugs Ther 11, 49–56 (1997). https://doi.org/10.1023/A:1007747806646
Issue Date:
DOI: https://doi.org/10.1023/A:1007747806646