Circulation, Vol 74, 1303-1308, Copyright © 1986 by American Heart Association
LW Stevenson and JH Tillisch
Therapy of elevated ventricular filling pressures in patients with dilated
heart failure may be limited by concern that cardiac output will be further
compromised. Twenty-five patients with severe symptoms and ejection
fractions of 25% or less were studied to determine the lowest ventricular
filling pressures that could be achieved with vasodilator and diuretic
therapy while maintaining cardiac output. In 20 of 25 patients normal
pulmonary capillary wedge pressures (PCWs) were achieved (mean 10 mm Hg
compared with 30 mm Hg at baseline). Stroke volume was 60 vs 39 ml at
baseline. Stroke work index was 30 vs 19 g-m/m2. For each patient, over the
range of PCWs, stroke volume and stroke work index were maintained and were
often maximal at the lowest PCW achieved. The upright position was well
tolerated in patients with normal supine PCW. Normal filling pressures can
be achieved in patients with congestive heart failure without compromise of
cardiac output. While congestive symptoms should be improved, the
feasibility and benefit of maintaining normal filling pressures over a long
term must be established.
ARTICLES
Maintenance of cardiac output with normal filling pressures in patients with dilated heart failure
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