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Acute changes of left atrial distensibility in congestive heart failure
J M Dernellis1, G P Vyssoulis, A A Zacharoulis
1First Cardiology Department, Amalia Fleming Hospital, Athens, Greece.
Insights
In congestive heart failure (CHF), acute administration of vasodilators or inotropics increases left atrial (LA) distensibility. Beta blockade or volume loading decreases LA distensibility.
Area of Science:
- Cardiology
- Physiology
Background:
- Left atrial (LA) distensibility is crucial for atrial function.
- LA distensibility has not been previously studied in congestive heart failure (CHF).
Purpose of the Study:
- To investigate the acute effects of esmolol, isosorbide dinitrate, dobutamine, and normal saline on LA dimension, pressure, and distensibility in CHF patients.
Main Methods:
- 23 CHF patients underwent acute infusions of various agents.
- Left atrial dimensions and pressures were measured.
- Passive elastic chamber stiffness and instantaneous diastolic LA distensibility were calculated.
Main Results:
- Normal saline and esmolol increased LA passive elastic chamber stiffness.
- Isosorbide dinitrate and dobutamine decreased LA passive elastic chamber stiffness.
- Isosorbide dinitrate and dobutamine increased LA distensibility, while normal saline and esmolol decreased it.
Conclusions:
- In CHF, LA distensibility can be acutely modulated.
- Vasodilators and inotropics increase LA distensibility.
- Beta-blockers and volume loading decrease LA distensibility.
Background:
Investigations of the left atrial (LA) distensibility have revealed that it plays a major role in atrial function; however, LA distensibility has not as yet been studied in congestive heart failure (CHF).
Hypothesis:
The study was undertaken to determine the effects of acute administration of esmolol, isosorbide dinitrate, dobutamine, and normal saline infusion on LA dimension, pressure, and distensibility.
Methods:
The study included 23 patients with CHF (18 with ischemic heart disease and 5 with idiopathic dilated cardiomyopathy). Left atrial diameters (D) and pressures (P) were recorded at rest and thereafter during acute tests. P and D data during the ascending limb of the V loop were fitted to the exponential function P = b.ead, where a is the passive elastic chamber stiffness constant and b is the elastic constant. The instantaneous diastolic LA distensibility (IDLAD) was calculated as 1/(dP/dD) = 1/a.P.
Results:
The constant, a, increased significantly after normal saline and esmolol infusion (p < 0.001), while it significantly decreased after isosorbide dinitrate (p < 0.001) and dobutamine administration (p < 0.05) compared with baseline. Instantaneous diastolic LA distensibility (in mm/Hg) was 0.16 at baseline; it significantly increased after isosorbide dinitrate (0.32) and dobutamine (0.24) administration, while it significantly decreased after normal saline (0.11) and esmolol (0.12) infusion (p < 0.001 for all).
Conclusion:
In CHF, LA distensibility may acutely increase with vasodilators or inotropics or may decrease with beta blockade or volume loading.
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