Analysis of left ventricular function in response to afterload changes in patients with mitral stenosis

In order to assess left ventricular function in patients with rheumatic mitral stenosis, left ventricular function curves (plotting stroke work index vs left ventricular end-diastolic pressure) were constructed using angiotensin to augment, and nitroprusside to reduce, afterload. Hemodynamic responses to these alterations in afterload were measured. Resting ejection fractions and qualitative assessment of left ventricular angiographic contraction abnormalities were also determined. Changes in left ventricular end-diastolic pressure following afterload interventions could be linearly related to changes in mean aortic pressure, but mitral valve gradients were unaffected. Afterload reduction with nitroprusside did not augment cardiac output. Afterload elevation with angiotensin significantly depressed both cardiac output and calculated mitral valve areas. Patients with normal resting ejection fractions evidenced normal ventricular function curves and those with depressed ejection fractions showed flat or declining function curves. Contraction abnormalities, generally in the posterobasal area, correlated well with abnormal left ventricular function curves.