Open AccessAcute changes of left atrial distensibility in congestive heart failure
Author(s) -
Dernellis John M.,
Vyssoulis Gregory P.,
Zacharoulis Apostolos A.,
Toutouzas Pavlos K.
Publication year - 1998
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960210106
Subject(s) - medicine , esmolol , isosorbide dinitrate , dobutamine , cardiology , heart failure , saline , diastole , vasodilation , sonomicrometry , hemodynamics , anesthesia , blood pressure , heart rate
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 cardiomypathy). 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·e ad , 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.