Article

Improvement of afterload mismatch of left atrial booster pump function with positive inotropic agent.

Second Department of Internal Medicine, Yamaguchi University School of Medicine, Japan.
Journal of the American College of Cardiology (impact factor: 14.16). 01/2001; 37(1):270-7. DOI:10.1016/S0735-1097(00)01060-3 pp.270-7
Source: PubMed

ABSTRACT The objective of this study was to examine the hypothesis that a positive inotropic agent improves left ventricular (LV) filling during left atrial (LA) contraction in the presence of markedly elevated LV filling pressure.
In patients with old myocardial infarction (MI), an increase in the operational LV chamber stiffness reduces LV filling during the LA contraction, resulting from an "afterload mismatch" of the LA booster pump function.
We investigated the effect of dobutamine infusion (3 microg/kg/min) on the LA pump function in the presence of elevated LV filling pressure induced by aortic constriction (Aoc) during acute MI in 10 dogs. Transmitral flow velocity was determined by transesophageal echocardiography, LV pressure by a micromanometer and LV volume by a conductance catheter. We measured the early (E) and late (A) diastolic peak transmitral flow velocities (cm/s) and LV chamber stiffness (deltaP/deltaV: mm Hg/ml; where deltaP is developed pressure and deltaV is the absolute filling volume during LA contraction).
When the deltaP/deltaV was increased by Aoc during MI (from 1.1 +/- 0.8 to 3.1 +/- 2.6 mm Hg/ml, p < 0.01), A decreased significantly (from 30 +/- 5 to 22 +/- 8 cm/s, p < 0.01), and the ratio of E to A increased (from 1.0 +/- 0.3 to 1.4 +/- 0.8, p < 0.05) compared with MI without Aoc, showing the pseudonormal transmitral flow pattern, the so called "LA afterload mismatch." Dobutamine under this condition significantly reduced the deltaP/deltaV (to 1.7 +/- 1.2 mm Hg/ml, p < 0.05), resulting in an increase in A (to 31 +/- 8 cm/s, p < 0.01) and a decrease in E/A (to 1.0 +/- 0.3, p < 0.05), and the transmitral flow became a prolonged relaxation pattern as in MI without Aoc in all dogs. There was an inverse correlation between the deltaP/deltaV and the time-velocity integral of A (r = -0.70, p < 0.01).
Dobutamine improved the afterload mismatch of the LA booster pump function. This effect may have been due to the reduction in LV operational chamber stiffness, resulting in an increase in the LA forward ejection into the LV.

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    Karsten E Schober, Imke Maerz
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Keywords

acute MI
 
aortic constriction
 
conductance catheter
 
dobutamine infusion
 
inverse correlation
 
LA afterload mismatch
 
LA booster pump function
 
LA pump function
 
LV chamber stiffness
 
LV operational chamber stiffness
 
LV pressure
 
old myocardial infarction
 
operational LV chamber stiffness
 
positive inotropic agent
 
pressure induced
 
prolonged relaxation pattern
 
pseudonormal transmitral flow pattern
 
time-velocity integral
 
transmitral flow
 
Transmitral flow velocity
 

H Sakai