Circulation, Vol 63, 263-268, Copyright © 1981 by American Heart Association
BH Greenberg, H DeMots, E Murphy and SH Rahimtoola
To determine how arteriolar dilation improves cardiac performance in aortic
insufficiency, we evaluated the acute effects of hydralazine in 10 patients
with chronic severe aortic insufficiency. Control measurements of
intracardiac and intravascular pressures, cardiac output and left
ventricular volumes were obtained at cardiac catheterization. Hydralazine,
0.3 mg/kg i.v. (maximal dose 20 mg), was administered and all measurements
were repeated 30 minutes later. A reduction in systemic vascular resistance
from 1264 to 710 dyn-sec-cm-5 was associated with significant increases in
forward cardiac index (2.9 to 5.1 l/min/m2) and stroke volume index (37 to
55 ml/m2). Left ventricular end-diastolic pressure was reduced from 19 to
12 mm Hg. There was a significant reduction in mean arterial pressure (88
to 83 mm Hg) and a significant increase in heart rate (81 to 94 beats/min).
Regurgitant stroke volume was reduced by more than 10 ml/m2 in seven
patients and for the group was significantly reduced, from 65 to 53 ml/m2.
Regurgitant fraction was reduced in all patients; the overall reduction
from 0.64 to 0.48 was highly significant. Ejection fraction increased more
than 0.10 in four patients, by 0.08 in an additional patient and for the
group increased significantly from 0.50 to 0.57. Left ventricular
end-diastolic volume decreased by more than 25 ml/m2 in four patients, by
19 ml/m2 in an additional patient and was decreased significantly, from 208
to 190 ml/m2, for the group. Arteriolar dilators improve cardiac
performance in aortic insufficiency by reducing the amount of aortic
regurgitation and, in some patients, by substantially improving systolic
pump fraction. These data suggest a role for arteriolar dilators in the
management of selected patients with aortic insufficiency.
ARTICLES
Mechanism for improved cardiac performance with arteriolar dilators in aortic insufficiency
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