Hemodynamic Assessment in the Medical Treatment of Acute Myocardial Infarction : The Effects of Various Vasodilators and Catecholamines : Diagnostic and Therapeutic Procedures in Acute Myocardial Infarcton

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One hundred and nineteen patients with acute myocardial infarction (AMI) were examined to establish the correlation between clinical and hemodynamic status. Patients were divided into 5 groups: uncomplicated AMI (Group A, 34 cases), congestive heart failure (Group B, 56 cases), cardiogenic shock (Group C, 14 cases), right ventricular dysfunction in cases with acute inferior infarction (Group D, 7 cases), and rupture of the interventricular septum (Group E, 8 cases). Hemodynamic classification of the first three groups with 18 mmHg for pulmonary arterial diastolic pressure (PADP) or pulmonary capillary pressure (PCW), 2.0 L/min/m^2 for cardiac index (CI), and 20 g・m/beat/m^2 for left ventricular stroke work index (LVSWI) correlated well with our clinical classification. In addition to hemodynamic measurements, monitoring of the temperature difference between the core and the periphery of the body reflects both cardiac function and clinical status of peripheral circulation and has been useful in selecting the appropriate therapy for AMI. Mortality rates were similar in the clinical and hemodynamic subset classifications, averaging 2.9% in Group A, 7.1% in Group B, 57.1% in Group C, 42.9% in Group D, and 62.5% in Group E. The hemodynamic effects of intravenous nitroglycerin (TNG), TNG ointment, and molsidomine were studied in 54 patients. All three vasodilators significantly reduced PADP or PCW and systemic vascular resistance (SVR), and increased CI in patients with elevated PADP or PCW. Also, TNG was effective in decreasing PADP or PCW, SVR, and left-to-right shunt ratio, and increasing forward cardiac output in Group E. However, in cases with severe pump failure in which CI was less than 2.1 L/min/m^2, LVSWI was less than 20 g・m/beat/m^2 and PADP or PCW was more than 18 mmHg, dopamine and a combination of dopamine and phentolamine produced beneficial hemodynamic responses. The overall early mortality rate of the AMI at our CCU decreased from 22.9% during 1974 to 1976, when no such therapy was applied, to 15.9% after therapy. A marked reduction in the mortality rate due to left ventricular failure from 33.3% to 13.5% was observed. Both hemodynamic and clinical data indicate that a new therapy employing vasodilators and a combination of vasodilators and catecholamines can be applied effectively in patients with pump failure following AMI.
社団法人日本循環器学会の論文
1981-05-20

Hemodynamic Assessment in the Medical Treatment of Acute Myocardial Infarction : The Effects of Various Vasodilators and Catecholamines : Diagnostic and Therapeutic Procedures in Acute Myocardial Infarcton

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