Pre-Load–Induced Changes in Forward LV Stroke and Functional Mitral Regurgitation
| Autor: | Kazuo Haze, Takahiko Naruko, Yukio Abe, Atsuko Furukawa, Yoshiki Matsumura, Minoru Yoshiyama, Kazato Ito, Kanako Akamatsu, Junichi Yoshikawa |
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| Rok vydání: | 2017 |
| Předmět: |
Cardiac function curve
medicine.medical_specialty Mitral regurgitation Ejection fraction biology business.industry Hazard ratio Starling 030208 emergency & critical care medicine 030204 cardiovascular system & hematology medicine.disease biology.organism_classification 03 medical and health sciences Preload 0302 clinical medicine Internal medicine Heart failure medicine Cardiology Radiology Nuclear Medicine and imaging Cardiology and Cardiovascular Medicine business Stroke |
| Zdroj: | JACC: Cardiovascular Imaging. 10:611-618 |
| ISSN: | 1936-878X |
| DOI: | 10.1016/j.jcmg.2016.07.010 |
| Popis: | Objectives The purpose of this study was to clarify the prognostic significance of diagnosing whether the failing heart is functioning on the descending limb of the Starling curve by using echocardiography with passive leg lifting (PLL). Background Patients with advanced heart failure can shift to the descending limb of the Starling curve, in which pre-load does not lead to an expected increase in forward left ventricular stroke volume (LVSV). Methods Thirty-five consecutive patients with left ventricular (LV) ejection fraction of Results Despite PLL, a paradoxical decrease in forward LVSV was observed in 15 (43%) patients. Changes in forward LVSV inversely correlated with those in functional mitral regurgitation (r = −0.56). The primary endpoint of cardiac death or hospitalization due to worsening heart failure occurred in 15 (43%) patients during follow-up (2.8 ± 2.2 years). There were a number of significant predictors of the primary endpoint in the univariate Cox analysis: baseline E/A ratio (p = 0.0002), paradoxical decrease in LVSV despite PLL (hazard ratio: 4.44; 95% confidence interval: 1.41 to 14.0; p = 0.011), baseline LV end-systolic volume (p = 0.023), and baseline LV ejection fraction (p = 0.034). In the bivariate Cox analysis, an addition of the paradoxical decrease in LVSV significantly enhanced the predictive power of all other univariate predictors. Conclusions Heart failure patients with LV systolic dysfunction on the descending limb of the Starling curve can be recognized by the paradoxical decrease in LVSV despite PLL, and the prognostic predicting power is additive to the other traditional echocardiographic predictors. Also, our results suggest that functional mitral regurgitation is an important reason for the descending limb of the Starling curve, which is clinically recognized as the pre-load–induced decrease in forward LVSV. |
| Databáze: | OpenAIRE |
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