Circulation, Vol 89, 2045-2053, Copyright © 1994 by American Heart Association
T Sharir, MD Feldman, H Haber, AM Feldman, A Marmor, LC Becker and DA Kass
BACKGROUND: Noninvasive cardiac-specific analysis of contractile function
in patients with dilated heart failure remains problematic. This study
tests whether maximal power divided by the square of end- diastolic volume
(PWRmx/EDV2, or preload-adjusted PWRmx) can provide such assessment.
METHODS AND RESULTS: To validate the load insensitivity of the PWRmx index
and determine its response to contractile change, 24 subjects with chronic
dilated cardiomyopathy underwent invasive pressure-volume catheterization
study using the conductance catheter technique. Preload was transiently
reduced by 30% using balloon occlusion of the inferior vena cava, and
afterload impedance was lowered by 50%, induced by a bolus injection of
nitroglycerin. Contractile state was varied by intravenous dobutamine,
verapamil, or esmolol. PWRmx was calculated from the simultaneous product
of ventricular pressure and rate of volume change (dV/dt), the latter
derived from the volume catheter signal. PWRmx varied directly with preload
but was minimally influenced by afterload. However, PWRmx/EDV2 was not
significantly altered by either loading change. PWRmx/EDV2 did vary with
contractility, correlating closely with changes in the end-systolic
pressure-volume relation (r = .91, P < .001). To test the noninvasive
application of this index, 12 additional patients were studied, with
PWRmx/EDV2 derived from nuclear ventriculography combined with a novel
method to measure central arterial pressures. Subjects received intravenous
nitroprusside or dobutamine in random order. Ejection fraction increased
similarly with both agents (+42.9 +/- 8.9% for dobutamine and +29.4 +/-
5.3% for nitroprusside, both P < .01). In contrast, PWRmx/EDV2 did not
significantly change with nitroprusside but increased by 126 +/- 16.1% with
dobutamine (P < .01). CONCLUSIONS: Preload-adjusted PWRmx is a
steady-state index of ventricular systolic function that is sensitive to
inotropic state and minimally influenced by physiological changes in
afterload impedance or volume load. It appears useful for noninvasive
cardiac-specific analysis of acute drug effects.
ARTICLES
Ventricular systolic assessment in patients with dilated cardiomyopathy by preload-adjusted maximal power. Validation and noninvasive application
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21268.
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