title: Sustained reduction in valvular regurgitation and atrial volumes with tailored vasodilator therapy in advanced congestive heart failure secondary to dilated (ischemic or idiopathic) cardiomyopathy.
abstract: Afterload reduction therapy can acutely improve hemodynamic function in patients with advanced heart failure; however, it is unknown if initial reductions in mitral and tricuspid regurgitation and atrial volumes can be sustained with oral therapy. Atrial volumes and atrioventricular valve regurgitation were measured using 2-dimensional and Doppler echocardiography with color-flow imaging in 14 patients with dilated heart failure (ejection fraction 17 +/- 4%) before and after 3 +/- 1 days of intensive vasodilator and diuretic therapy tailored to hemodynamic goals. Echocardiography was repeated again after 6 +/- 2 months on oral vasodilators and a flexible diuretic regimen. Acute therapy reduced systemic vascular resistance from 1,760 +/- 460 to 1,010 +/- 310 dynes.s.cm-5, pulmonary artery wedge pressure from 30 +/- 5 to 17 +/- 4 mm Hg, and right atrial pressure from 13 +/- 5 to 7 +/- 3 mm Hg, and led to a 61% increase in stroke volume (from 36 +/- 10 to 58 +/- 14 ml) (p less than 0.01). Mitral and tricuspid regurgitation, determined by color-flow fraction, initially decreased from 0.34 +/- 0.17 to 0.20 +/- 0.20 and from 0.33 +/- 0.15 to 0.13 +/- 0.13, respectively (p less than 0.001). This reduction was sustained at 6 months. Significant decreases occurred with acute therapy, with further reductions at 6 months in both mean left atrial volume (from 100 +/- 25 to 80 +/- 19 to 65 +/- 15 cm3) and right atrial volume (from 85 +/- 23 to 64 +/- 23 to 52 +/- 14 cm3) (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: UCLA School of Medicine, Division of Cardiolog 90024-1679.
authors.forename: M A
authors.initials: MA
authors.lastname: Hamilton
authors.forename: L W
authors.initials: LW
authors.lastname: Stevenson
authors.forename: J S
authors.initials: JS
authors.lastname: Child
authors.forename: J D
authors.initials: JD
authors.lastname: Moriguchi
authors.forename: J
authors.initials: J
authors.lastname: Walden
authors.forename: M
authors.initials: M
authors.lastname: Woo
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000704:Analysis of Variance; D016275:Atrial Function; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D004232:Diuretics / Q000008:administration & dosage* / Q000627:therapeutic use; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000188:drug therapy; D015588:Observer Variation; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000188:drug therapy; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D014665:Vasodilator Agents