Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

doi:10.1016/0002-9149(87)90376-6

The American Journal of Cardiology

Volume 60, Issue 8, 15 September 1987, Pages 654-658

https://doi.org/10.1016/0002-9149(87)90376-6 Get rights and content

Abstract

The mechanism by which afterload reduction increases left ventricular stroke volume while decreasing left ventricular filling pressure has not previously been established. In 15 patients with severe congestive heart failure due to ischemic or idiopathic dilated cardiomyopathy, absolute ventricular volume, ejection fraction and total stroke volume from radionuclide ventriculography were compared with thermodilution stroke volume before and after intensive afterload reduction with vasodilators and diuretics titrated to hemodynamic goals. After 48 to 72 hours, pulmonary artery wedge pressure decreased from 32 ± 8 to 16 ± 4 mm Hg and systemic vascular resistance from 1,960 ± 700 to 1,200 ± 400 dynes s cm⁻⁵. End-diastolic volume decreased from 390 ± 138 to 301 ± 126 ml (p < 0.01) and end-systolic volume from 316 ±127 to 241 ± 111 (p < 0.01). Ejection fraction did not change and total stroke volume decreased from 74 ± 22 to 59 ± 20 ml (p < 0.01). Simultaneous forward stroke volume by thermodilution increased from 37 ± 14 to 52 ± 14 ml (p < 0.01), and forward fraction increased from 0.55 ± 0.40 to 0.96 ± 0.42. Intensive reduction of ventricular filling pressure and systemic vascular resistance decreased total ventricular stroke volume by 20% but increased forward stroke volume by 40%. The major effect of intensive afterload reduction for severe congestive heart failure may be the reduction of ventricular volume and mitral regurgitation.

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Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

Abstract

Am J Cardiol

JAGG

JACC

Am J Cardiol

Am J Cardiol

Am J Card

Am J Cardiol

Am J Cardiol

Maintenance of cardiac output with normal filling pressures in patients with dilated heart failure

Circulation

Controlled trial of captopril in chronic heart failure: a rest and exercise hemodynamic study

Circulation

Rest and exercise hemodynamic effects of oral hydralazine in patients with coronary artery disease and left ventricular dysfunction

Circulation

Vasodilators: rationale, application and future prospects