Circulation, Vol 79, 854-862, Copyright © 1989 by American Heart Association
FC Yin, KP Brin, CT Ting and RE Pyeritz
Aortic impedance, wave reflection magnitude, and compliance were measured
in patients with Marfan's syndrome during diagnostic cardiac
catheterization. Impedance and wave reflections were calculated from
standard Fourier series analysis of ascending aorta micromanometer pressure
and electromagnetic flow records. Compliance was estimated by a method
recently proposed that uses the area under the pressure-time curve assuming
a two-element Windkessel model of the circulation. Measurements were made
in the baseline state, during vasodilatation with nitroprusside, after
beta-adrenergic receptor blockade with intravenous propranolol, and during
vasodilatation after beta-blockade. Marfan's syndrome produces alterations
from normal in some hemodynamic variables: during baseline conditions, the
magnitude of wave reflection was higher than in normal patients. This was
normalized by vasodilatation and further increased by beta-blockade.
Despite the greatly dilated aortic root, the aortic characteristic
impedance was in the normal range, suggesting increased aortic wall
stiffness. The baseline total arterial compliance was greatly increased
with nitroprusside and was reduced by beta-blockade. beta-Blockade did not
decrease the maximum acceleration of blood into the ascending aorta. These
are the first detailed measurements of hemodynamic indexes in this disease.
The results suggest that acute beta-blockade is not necessarily beneficial
in reducing hemodynamic loading on an already dilated aortic root.
ARTICLES
Arterial hemodynamic indexes in Marfan's syndrome
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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