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[Infusion of plasma volume expanders in the evaluation of left ventricular function (author's transl)]
Insights
Low molecular weight dextran infusion effectively assesses hemodynamic function in patients with cardiovascular diseases, including myocardial infarction and hypertension. This test reveals distinct responses across different patient groups, aiding in diagnosis.
Area of Science:
- Cardiovascular Medicine
- Clinical Hemodynamics
- Pharmacological Testing
Background:
- Assessing left ventricular function is crucial in managing various cardiovascular conditions.
- Existing methods for hemodynamic assessment may have limitations in differentiating disease-specific responses.
- Low molecular weight dextran has been explored for its potential in fluid management and hemodynamic evaluation.
Purpose of the Study:
- To evaluate the utility of intravenous low molecular weight dextran infusion as a diagnostic tool for hemodynamic assessment.
- To compare the hemodynamic responses to dextran infusion in patients with distinct cardiovascular diseases: previous myocardial infarction, ischemic heart disease, hypertension, and cerebrovascular disease.
- To analyze left ventricular function parameters, including Left Ventricular Stroke Work Index (LVSWI) and Left Ventricular Filling Pressure (LVFP), during dextran administration.
Main Methods:
- Thirty-nine patients were divided into four groups based on their cardiovascular condition.
- Intravenous low molecular weight dextran was administered during right heart catheterization.
- Left ventricular function curves (LVSWI-LVFP relationship) were measured at multiple time points: before infusion, during infusion, at peak LVSWI, and at the end of infusion.
Main Results:
- Initial LVSWI and stroke volume (SV) were significantly lower in the myocardial infarction group compared to others.
- Dextran infusion increased LVFP in all groups, and SV and LVSWI in the myocardial infarction and hypertension groups.
- Significant differences in LVSWI and LVFP were observed among the groups post-infusion. The deltaV/deltaLVFP index varied significantly across the groups (56, 67, 73, 138 ml/mmHg for groups I-IV, respectively).
Conclusions:
- Intravenous low molecular weight dextran infusion serves as a valuable test for the hemodynamic assessment of diverse cardiovascular diseases.
- The study demonstrates differential hemodynamic responses to dextran, highlighting its potential to distinguish between patient subgroups.
- Further research could explore the specific clinical applications and optimal use of dextran in cardiovascular diagnostics.
Abstract:
39 patients, subdivided in four groups [I) previous myocardial infarction; II) ischaemic heart disease; III) hypertension; IV) cerebrovascular disease] were administered i.v. low molecular weight dextran in the course of right heart catheterization. The curves of the left ventricular function were determined by the LVSWI-LVFP relationship measured before the test, after the first 150 ml of dextran infusion, at the point of maximal increase of the LVSWI, and at the end of the infusion. The initial values of the LVSWI and SV were lower in the first group with respect to the other three (P less than 0.001), not significantly unlike those of the LVFP. During dextran infusion it is possible to observe an increase of the LVFP in all four groups (P less than 0.01), and of the SV (P less than 0.02) and LVSWI (P less than 0.01 and P less than 0.05, respectively) in the first and the third groups. At the end of the test, different values of the LVSWI (P less than 0.001) and the LVFP (P less than 0.01) were observed in the four groups. The calculated deltaSI/deltaLVFP indices were not significantly different in the four groups, whereas a P less than 0.001 was obtained for the values of the deltaV/deltaLVFP indices (56, 67, 73 and 138 ml/mmHg for the groups I, II, III and IV, respectively). Dextran infusion proved to be a useful test for the hemodynamic assessment of different cardiovascular diseases.