Excessive vasoconstriction in rheumatic mitral stenosis with modestly reduced ejection fraction

Wisenbaugh, Thomas; Essop, Rafique; Middlemost, Shirley; Skoularigis, John; Sareli, Pinhas

doi:10.1016/0735-1097(92)90246-j

Cited by 32 publications

(7 citation statements)

References 24 publications

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“…14) could be explained by differences in body surface area (1.8 Ϯ 0.3 vs. 1.5 Ϯ 0.12 m 2 ). In our study, the 67-ml SV value was consistent with the 58-ml value previously reported (29,30). SV did not significantly change after BVM, as reported in some studies (7,19).…”

Section: Comparison With Previous Studiessupporting

confidence: 93%

“…SV did not significantly change after BVM, as reported in some studies (7,19). Others have reported that SV increased after BMV (14,29). These disparities may be related to differences in the incidence and severity of mitral regurgitation and atrial shunts after BMV.…”

Section: Comparison With Previous Studiesmentioning

confidence: 65%

“…Because BMV did not modify SV, the increase in Ea was mainly explained by the significant increase in both ESAP and MAP in all patients. In two previous studies (6,29), MAP was not significantly modified by BMV, but it must be noted that patients were premedicated with atenolol in the study of Wisenbaugh et al (29), and this may have minimized reflex changes in aortic pressure.…”

Section: Relationship Between Ea and R/t In Ms Patients At Baseline Amentioning

confidence: 86%

“…INCREASED AFTERLOAD has been proposed as one of the causal factors of left ventricular (LV) systolic dysfunction observed in ϳ30% of patients with pure mitral stenosis (MS) (5). In this subgroup of patients, both the relatively thin-walled LV chamber and the presence of high systemic vascular resistance result in abnormally high end-systolic wall stress (5,29). Given impaired LV filling, some researchers have reported that this elevation in afterload was not offset by the Frank-Starling mechanism, thus leading to low ejection performance (5); others have suggested that decreased intrinsic contractility may also be involved (18).…”

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confidence: 99%

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Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy

Colin

Slama

Vahanian

et al. 1997

Journal of Applied Physiology

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This study had the purpose of documenting the hemodynamic correlates of effective arterial elastance (Ea; i.e., an accurate estimate of hydraulic load) in mitral stenosis (MS) patients. The main hypothesis tested was that Ea relates to the total vascular resistance (R)-to-pulse interval duration (T) ratio (R/T) in MS patients both before and after successful balloon mitral valvotomy (BMV). High-fidelity aortic pressure recordings were obtained in 10 patients (40 +/- 12 yr) before and 15 min after BMV. Ea value was calculated as the ratio of the steady-state end-systolic aortic pressure (ESAP) to stroke volume (thermodilution). Ea increased after BMV (from 1.55 +/- 0.63 to 1.83 +/- 0.71 mmHg/ml; P < 0.05). Throughout the procedure, there was a strong linear relationship between Ea and R/T: Ea = 1.09R/T - 0.01 mmHg/ml, r = 0.99, P = 0.0001. This ultimately depended on the powerful link between ESAP and mean aortic pressure [MAP; r = 0.99, 95% confidence interval for the difference (MAP - ESAP) from -18.5 to +4.5 mmHg]. Ea was also related to total arterial compliance (area method) and to wave reflections (augmentation index), although to a lesser extent. After BMV, enhanced and anticipated wave reflections were observed, and this was likely to be explained by decreased arterial compliance. The present study indicated that Ea depended mainly on the steady component of hydraulic load (i.e., R) and on heart period (i.e., T) in MS patients.

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Section: Comparison With Previous Studiessupporting

confidence: 93%

Section: Comparison With Previous Studiesmentioning

confidence: 65%

Section: Relationship Between Ea and R/t In Ms Patients At Baseline Amentioning

confidence: 86%

mentioning

confidence: 99%

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Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy

Colin

Slama

Vahanian

et al. 1997

Journal of Applied Physiology

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“…valvuloplasty . This may be explained by one or more of the following mechanisms: increased afterload due to.excessive vasoconstriction [9], blood loss with decreased venous return, left to right were not estimated before and after dilatation. In contrast, the Inoue double-lumen catheter which was used in all of our patients has the advantage of a self-positioning mechanism (i.e., it anchors to the mitral valve during inflation), which avoids the slippage that may otherwise cause significant trauma to the endocardium during inflation.…”

Section: Discussionmentioning

confidence: 84%

Effect of percutaneous balloon mitral valvuloplasty on serum creatinine phosphokinase MB‐isoenzyme levels

Yip

Chow

et al. 1993

Cathet. Cardiovasc. Diagn.

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Twenty-one patients with moderate to severe mitral stenosis were treated with percutaneous balloon mitral valvuloplasty (PBMV) using Inoue mitral double-lumen balloon catheters. Creatinine phosphokinase MB isoenzyme (CPK-MB) levels were measured at baseline, 5 min, 6 h, and 18 h post dilatation. Haemodynamic indexes, 12-lead ECGs, and 2-dimensional echocardiograms were performed to evaluate systolic function postprocedure. CPK-MB levels were modestly increased at 5 min and at 6 h postprocedure compared with the baseline level (p < 0.001) but were still within the normal reference range, except for one patient who had a level at 5 min minimally above the upper limit of normal. CPK-MB levels were not significantly increased at 18 h after the procedure. No significant changes in ejection fractions, 12-lead ECGs, and regional wall motion occurred in any of the patients studied. In conclusion, PBMV causes modest early elevation of CPK-MB. This elevation is not associated with changes in LV systolic function and does not interfere with the diagnosis of acute myocardial infarction using the enzyme elevation criteria.

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Mitralstenose

Roskamm¹,

Reindell²,

Barmeyer³

et al. 2004

Herzkrankheiten

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Excessive vasoconstriction in rheumatic mitral stenosis with modestly reduced ejection fraction

Cited by 32 publications

References 24 publications

Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy

Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy

Effect of percutaneous balloon mitral valvuloplasty on serum creatinine phosphokinase MB‐isoenzyme levels

Mitralstenose

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