CBS 2019
CBSMD教育中心
中 文

Other Relevant Articles

Abstract

Recommended Article

Genetic dysregulation of endothelin-1 is implicated in coronary microvascular dysfunction Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry A prospective natural-history study of coronary atherosclerosis Impact of Coronary Lesion Complexity in Percutaneous Coronary Intervention: One-Year Outcomes From the Large, Multicentre e-Ultimaster Registry Healthy Behavior, Risk Factor Control, and Survival in the COURAGE Trial Ten-Year Clinical Outcomes From a Trial of Three Limus-Eluting Stents With Different Polymer Coatings in Patients With Coronary Artery Disease Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data A Novel Familial Cardiac Arrhythmia Syndrome with Widespread ST-Segment Depression
|<<... 22 23 24 25 26 27 28 ...>>|

Original Research2017 Sep 12;70(11):1339-1348.

JOURNAL：J Am Coll Cardiol. Article Link

Hemodynamic Response to Nitroprusside in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

Lloyd JW, Nishimura RA, Eleid MF et al. Keywords: aortic stenosis; catheterization; low gradient; nitroprusside; pathophysiology

ABSTRACT


BACKGROUND - Low-gradient severe aortic stenosis (LGSAS) with preserved ejection fraction (EF) is incompletely understood. The influence of arterial afterload and diastolic dysfunction on the hemodynamic presentation of LGSAS remains unknown.


OBJECTIVES - The authors sought to determine the acute hemodynamic response to sodium nitroprusside in LGSAS with preserved EF.


METHODS - Symptomatic patients with LGSAS and preserved EF underwent cardiac catheterization with comparison of hemodynamic measurements before and after nitroprusside.


RESULTS - Forty-one subjects (25 with low flow [LF], stroke volume index [SVI] ≤35 ml/m2, 16 with normal flow [NF]) were included. At baseline, LF patients had lower total arterial compliance (0.36 ± 0.12 ml/m2/mm Hg vs. 0.48 ± 0.16 ml/m2/mm Hg; p = 0.01) and greater effective arterial elastance (2.77 ± 0.84 mm Hg · m2/ml vs. 1.89 ± 0.82 mm Hg · m2/ml; p = 0.002). In all patients, nitroprusside reduced elastance, left ventricular filling pressures, and pulmonary artery pressures and improved compliance (p < 0.05). Aortic valve area increased to ≥1.0 cm2 in 6 LF (24%) and 4 NF (25%) subjects. Change in SVI with nitroprusside varied inversely to baseline SVI and demonstrated improvement in LF only (3 ± 6 ml/m2; p = 0.02).


CONCLUSIONS - Nitroprusside reduces afterload and left ventricular filling pressures in patients with LGSAS and preserved EF, enabling reclassification to moderate stenosis in 25% of patients. An inverse relationship between baseline SVI and change in SVI with afterload reduction was observed, suggesting that heightened sensitivity to afterload is a significant contributor to LF-LGSAS pathophysiology. These data highlight the utility of afterload reduction in the diagnostic assessment of LGSAS.



>CBS CBS 2019

> CBS 2019 REGISTRATION

> CBS 2019 PROGRAM

> CBS 2019 CALL FOR SCIENCE

> CBS 2019 SPOTLIGHTS

 CBSMD

> CBSMD WEBSITE REGISTRATION

> EDUCATION CENTER

> RECOMMANDED PAPER

> TOP 10 RESEARCH PAPER

> PRE-READING

CBS 2019 CBS 2019 FACULTY Education Resource CBSMD Scientific Library
Copyright ⓒ CBS MD Nanjing China. All rights reserved. 京ICP备16025898号-11
联系我们| Top