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[Changes in left ventricular inflow and pulmonary venous flow patterns during preload alteration in dilated heart]
1Second Department of Internal Medicine, University of Tokushima.
Journal of Cardiology
|January 1, 1994
Summary
This study shows that left ventricular inflow (LVIF) and pulmonary venous flow (PVF) patterns change with altered preload in patients with dilated heart conditions. These flow patterns can shift between pseudonormalization (PN) and decreased early diastolic wave (N-PN) patterns during lower body positive pressure and negative pressure tests.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Echocardiography
Background:
- Dilated heart conditions, including dilated cardiomyopathy and myocardial infarction, often involve diastolic dysfunction.
- Assessing diastolic function is crucial for managing heart failure and predicting outcomes.
- Transesophageal Doppler echocardiography offers insights into cardiac flow dynamics.
Purpose of the Study:
- To investigate changes in left ventricular inflow (LVIF) and pulmonary venous flow (PVF) patterns during preload alterations in patients with dilated hearts.
- To differentiate between pseudonormalization (PN) and decreased early diastolic wave (N-PN) patterns of LVIF.
- To correlate these flow patterns with hemodynamic parameters.
Main Methods:
- Transesophageal Doppler echocardiography was performed on 30 patients with dilated hearts and 20 healthy controls.
- Preload was altered using lower body negative pressure (LBNP) and lower body positive pressure (LBPP).
- LVIF and PVF patterns were analyzed, including early diastolic wave (E), atrial contraction wave (A), pulmonary venous diastolic wave (PVD), and second systolic wave (PVS2).
Main Results:
- In control conditions, 8 patients showed a PN pattern and 22 showed an N-PN pattern of LVIF.
- Patients with the PN pattern had higher PVD and E, and lower PVS2 and A compared to the N-PN group.
- The atrial contraction wave (PVA) of PVF was larger in dilated heart patients than in controls.
- LVIF patterns shifted between PN and N-PN during preload alterations.
- Increased pulmonary capillary wedge pressure (PCWP) was observed in patients who shifted from N-PN to PN pattern.
Conclusions:
- LVIF and PVF patterns are dynamic and responsive to preload changes in dilated heart conditions.
- The PN and N-PN patterns represent different stages or manifestations of diastolic dysfunction.
- Doppler echocardiography during preload manipulation can help characterize diastolic function and identify patients at risk.