Circulation, Vol 80, 306-313, Copyright © 1989 by American Heart Association
G Keren, S Katz, J Strom, EH Sonnenblick and TH LeJemtel
Cardiac performance and mitral regurgitation were measured by Doppler
echocardiography and right heart catheterization in 12 patients with severe
congestive heart failure who performed isometric exercise during control
and intravenous administration of dobutamine and nitroglycerin. During
control isometric exercise, mitral regurgitant volume increased from 18 +/-
13 to 31 +/- 17 ml (p less than 0.01), while forward stroke volume, by both
thermodilution and Doppler echocardiography, substantially decreased. At
rest, dobutamine decreased mitral regurgitant volume from 18 +/- 13 to 11
+/- 10 ml (p less than 0.05), while forward stroke volume increased from 46
+/- 13 to 55 +/- 15 ml (p less than 0.05). During isometric exercise,
dobutamine tended to decrease mitral regurgitant volume (24 +/- 12 vs. 31
+/- 17 ml; NS) when compared with control exercise. At rest, nitroglycerin
decreased mitral regurgitant volume from 18 +/- 13 to 11 +/- 11 ml (p less
than 0.05), while forward stroke volume, by both thermodilution and Doppler
echocardiography, substantially increased. Similarly, during isometric
exercise, nitroglycerin decreased mitral regurgitant volume from 31 +/- 17
to 20 +/- 14 ml (p less than 0.05), while significantly increasing forward
stroke volume. At control rest, the median mitral regurgitant fraction was
24% for the 12 patients. Neither dobutamine nor nitroglycerin changed
significantly forward stroke and mitral regurgitant volumes at rest and
during isometric exercise in the six patients with resting mitral
regurgitant fraction below the median. In contrast, dobutamine and
nitroglycerin significantly decreased mitral regurgitant volume and
increased forward stroke volume both at rest and during isometric exercise
in the six patients with mitral regurgitant fraction greater than the
median.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Dynamic mitral regurgitation. An important determinant of the hemodynamic response to load alterations and inotropic therapy in severe heart failure
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.
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