Ventricular-load Optimization in Patients with Heart Failure : CLINICAL EVALUATION OF CARDIAC PERFORMANCE
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概要
- 論文の詳細を見る
The effects of unloading or inotropic agent in 22 patients with dilated cardiomyopathy were assessed in terms of optimal coupling between the ventricle and arterial system. In 13 patients (group A), Iower body negative pressure (LBNP) was applied to reduce preload and nitroprusside was used to decrease afterload. In 9 patients (group B), dobutamine was used to enhance inotropic state. In all patients, the direct arterial pressure was simultaneously recorded with left ventricular echocardiogram as the pressure was elevated by pheny-lephrine. The left ventricular contractile properties were defined by the slope (Ees) of the end-systolic pressure-volume relation. The arterial system properties were expressed by the slope (Ea) of the end-systolic pressure-stroke volume relation. When the Ea/Ees ratio ranged from 0.5 to I .O, both external work and mechanical efficiency are nearly maximized, In group A, baseline ventricular-load coupling was characterized by an increase in the Ea/Ees ratio (1.96 ± 1.08) where the heart could maximize neither external work nor mechanical efficiency. Ea/Ees significantly fell to I .45 ± 0.77 with nitroprusside, while increasing to 2.37± 1.17 during LBNP. In group B, Ea/Ees was decreased from 1 .43 ± to 0.82 + 0.47 with dobutamine. It is concluded that reduction in after-load rather than preload, or augmentation of contractility could restore optimal ventricular-load coupling in patients with severe cardiac dysfunction.
- 社団法人日本循環器学会の論文
- 1992-07-20
著者
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Sasayama Shigetake
The Second Department Of Internal Medicine Toyama Medical And Pharmaceutical University
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Kameyama Tomoki
The Second Department of Internal Medicine, University of Toyama
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Asanoi Hidetsugu
The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
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Ishizaka Shinji
The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
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Asanoi Hidetsugu
The Second Department Of Internal Medicine Toyama Medical & Pharmaceutical University
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Kameyama Tomoki
The Second Department Of Internal Medicine Toyama Medical And Pharmaceutical University
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Ishizaka Shinji
The 2nd Department Of Internal Medicine University Of Toyama
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Asanoi Hidetsugu
The 2nd Department Of Internal Medicine And Department Of Radiology Toyama Medical And Pharmaceutica
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Sasayama Shigetake
The 2nd Department Of Internal Medicine Toyama Medical & Pharmaceutical University
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Sasayama Shigetake
The Second Dept. Of Internal Medicine Toyama Medical And Pharmaceutical University
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