Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

Stevenson, Lynne Warner; Bellil, D.; Grover‐McKay, Maleah; Brunken, Richard C.; Schwaiger, Markus; Tillisch, Jan H.; Schelbert, Heinrich R.

doi:10.1016/0002-9149(87)90376-6

Cited by 158 publications

(53 citation statements)

References 21 publications

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“…23,24 High wall stress has also been shown to promote apoptosis and necrosis of myocytes, a process that is probably not reversible and further promotes adverse remodeling. 25 Therapies such as vasodilators, LV assist devices, and cardiac restraint devices have been shown to attenuate ventricular remodeling, 11,13,14 which supports the concept that methods to unload areas of high wall stress may be useful in preventing ventricular remodeling. Electrical preexcitation has also been shown in other experiments to reduce local work and, presumably, preload, while increasing them in remote, late-activated regions.…”

Section: Discussionmentioning

confidence: 89%

“…[7][8][9][10] Unloading the LV with vasodilators and cardiac support devices reduces wall stress, which may be one mechanism by which these devices attenuate adverse remodeling and improve long-term outcomes. [11][12][13][14] An alternative method for unloading areas of high wall stress is electrical preexcitation. Electrical preexcitation has previously been shown to modify, in the short term, the regional distribution of stroke work within the normal heart, reducing stroke work near the site of preexcitation and increasing stroke work in regions remote from it.…”

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confidence: 99%

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Ventricular Preexcitation Modulates Strain and Attenuates Cardiac Remodeling in a Swine Model of Myocardial Infarction

et al. 2007

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Background-Myocardial infarction modifies the distribution of stress within the heart, increasing wall stress in ischemic and surrounding tissue, which often leads to adverse left ventricular remodeling. Electrical preexcitation pacing with appropriate timing of high-stress regions can reduce local strain and may attenuate global remodeling. Methods and Results-Myocardial infarction was induced in 24 swine to study the short-term (nϭ12) and long-term (nϭ12) effects of therapy. Sonomicrometry and hemodynamic measurements were used to show the mechanistic effects of preexcitation and to determine the optimal stimulation site and atrioventricular delay. Lagrangian strain was used to assess regional loading characteristics. Long-term study animals were randomized to 8 weeks of preexcitation (therapy) or no pacing (control). Echocardiograms were performed 2 days after myocardial infarction and repeated at 60 days, when tissue weights and apoptosis were assessed. Preexcitation reduced regional strain in the short term, with the best results achieved when the border region was paced at an atrioventricular delay of 50% of the intrinsic PR interval. In the long term, the changes in left ventricular internal diameter and left atrial size were decreased in therapy animals versus control animals (0.9Ϯ0.3 versus 1.5Ϯ0.5 cm, Pϭ0.03, and 1.06Ϯ0.78 versus 2.32Ϯ0.88 cm, PϽ0.04, respectively). Heart weight was significantly lower in the therapy animals than in the control animals (319.8Ϯ20.8 versus 359.6Ϯ29.3 g, Pϭ0.02). Although not significant, cardiomyocyte apoptosis trended lower in the therapy group. Conclusions-Preexcitation of the left ventricle after myocardial infarction reduced strain and stroke work in the infarct and border regions in the short term and attenuated adverse ventricular remodeling in the long term.

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Section: Discussionmentioning

confidence: 89%

mentioning

confidence: 99%

Ventricular Preexcitation Modulates Strain and Attenuates Cardiac Remodeling in a Swine Model of Myocardial Infarction

et al. 2007

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“…In addition, most patients with systolic HF have functional mitral regurgitation that will cause overestimation of the LVEF, as it measures both forward and regurgitant flow. A reduction in mitral regurgitation causing an improvement in forward stroke volume may reduce LVEF [21]. Therefore, if mitral regurgitant fraction decreased, a small increase in LVEF would indicate a relatively large increase in nonregurgitant stroke volume and, therefore, be associated with a large decrease in LECT.…”

Section: Sleep-related Disorders CM Ryan Et Almentioning

confidence: 99%

Shift in sleep apnoea type in heart failure patients in the CANPAP trial

Ryan

Floras²,

Logan³

et al. 2010

European Respiratory Journal

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“…Whether the development of functional mitral MR significantly worsens left ventricular remodeling through volume overload and whether correction of the regurgitation favorably affects the clinical course of the disease remains controversial. Vasodilators, β-blockers and cardiac resynchronization therapies appear to lead to progressive decrease in the severity of MR over time with favorable clinical results [25][26][27][28]. It is unknown whether these improved clinical outcomes are mediated through a reduction in MR, or whether decreased MR merely reflects favorable ventricular remodeling.…”

Section: Mitral Valve Repair For Secondary Mitral Regurgitationmentioning

confidence: 99%

Advances in the surgical treatment of heart failure

Allen

Felker

2008

Current Opinion in Cardiology

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Purpose of review-Despite advancements in medical therapy, morbidity and mortality remain high. Surgical treatment of heart failure has been the subject of renewed focus, with a particular emphasis on applying the principles of evidence-based medicine to the evaluation of surgical therapies. The purpose of this review is to discuss emerging surgical therapies in heart failure, in particular, mechanical cardiac support and mitral valve repair.

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Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

Cited by 158 publications

References 21 publications

Ventricular Preexcitation Modulates Strain and Attenuates Cardiac Remodeling in a Swine Model of Myocardial Infarction

Ventricular Preexcitation Modulates Strain and Attenuates Cardiac Remodeling in a Swine Model of Myocardial Infarction

Shift in sleep apnoea type in heart failure patients in the CANPAP trial

Advances in the surgical treatment of heart failure

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