Splanchnic Venous Pressure–Volume Relation During Experimental Acute Ischemic Heart Failure

Wang, Steven Y.; Manyari, Dante E.; Scott-Douglas, Nairne; Smiseth, Otto A.; Smith, Eldon R.; Tyberg, John V.

doi:10.1161/01.cir.91.4.1205

Cited by 40 publications

(36 citation statements)

References 44 publications

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“…This reference was used when stressed volume was changed to predict circulatory equilibrium. In six other dogs, left ventricular failure was induced by embolization of the left circumflex coronary artery with glass microspheres (90 m diameter) (35). We adjusted the number of microspheres to increase P LA by 20 mmHg.…”

Section: Experimental Protocolmentioning

confidence: 99%

“…The intersection reached a new equilibrium point, where P LA increased drastically (15.9 mmHg) with a slight increase in P RA and a partial recovery of CO. Although this analysis is hypothetical, the graphical analysis represents the typical hemodynamics of left heart failure (2,4,10,23,35). Notwithstanding its simplicity, the framework for the venous return surface provides a very powerful tool for analysis of complicated hemodynamics in the clinical setting.…”

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confidence: 99%

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A novel framework of circulatory equilibrium

Uemura

Sugimachi

Kawada

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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A novel framework of circulatory equilibrium was developed by extending Guyton's original concept. In this framework, venous return (CO V) for a given stressed volume (V) was characterized by a flat surface as a function of right atrial pressure (P RA) and left atrial pressure (PLA) as follows: COV ϭ V/W Ϫ G SPRA Ϫ GPPLA, where W, GS, and GP denote linear parameters. In seven dogs under total heart bypass, CO V, PRA, PLA, and V were varied to determine the three parameters in each animal with use of multivariate analysis. The coefficient of determination (r 2 ϭ 0.92-0.99) indicated the flatness of the venous return surface. The averaged surface was CO V ϭ V/0.129 Ϫ 19.61PRA Ϫ 3.49PLA. To examine the invariability of the surface parameters among animals, we predicted the circulatory equilibrium in response to changes in stressed volume in another 12 dogs under normal and heart failure conditions. This was achieved by equating the standard surface with the individually measured cardiac output (CO) curve. In this way, we could predict CO [y ϭ 0.90x ϩ 5.6, r 2 ϭ 0.95, standard error of the estimate (SEE) ϭ 8.7 ml ⅐ min Ϫ1 ⅐ kg Ϫ1 ], PRA (y ϭ 0.96x, r 2 ϭ 0.98, SEE ϭ 0.2 mmHg), and P LA (y ϭ 0.89x ϩ 0.5, r 2 ϭ 0.98, SEE ϭ 0.8 mmHg) reasonably well. We conclude that the venous return surface accurately represents the venous return properties of the systemic and pulmonary circulations. The characteristics of the venous return surface are invariable enough among animals, making it possible to predict circulatory equilibrium, even if those characteristics are unknown in individual animals. venous return; cardiac output; hemodynamics THE FRAMEWORK FOR CIRCULATORY EQUILIBRIUM was pioneered by Guyton and associates in the 1950s (14 -17). They characterized the venous return properties of the systemic vein by the venous return curve and the apparent pumping ability of the cardiothoracic compartment by the cardiac output (CO) curve (Fig. 1A). The intersection of the two curves determines equilibrium CO and right atrial pressure (P RA ) (14). This concept clearly defined the circulatory equilibrium under rather simple pathophysiological conditions, such as hemorrhage and exercise, and deepened our understanding of control mechanisms of CO. However, because the original framework lumped various subsystem components, such as the right ventricle, pulmonary vascular system, and left ventricle, into a single cardiothoracic compartment, the lack of consideration of the venous return properties of the pulmonary circulation and the pumping ability of the individual ventricles makes it difficult to define the circulatory equilibrium under more complex conditions such as unilateral ventricular failures, which are often seen in clinical settings (2). In other words, redistribution of blood between the systemic and pulmonary circulations cannot be defined by their original framework.To deal with the blood redistribution, Guyton et al. (15) modified the original framework and developed a two-compartment model. However, the analysis of hem...

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Section: Experimental Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

A novel framework of circulatory equilibrium

Uemura

Sugimachi

Kawada

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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“…We speculated that the baseline venoconstriction associated with heart failure could cause these dogs to be more sensitive to the venodilating effects of 5-ISMN than normal dogs. 5 Dogs with severe CHF that were already receiving a large dose of a diuretic and an angiotensin-converting enzyme inhibitor were chosen, to simulate the clinical situation in which adjunctive heart failure therapy is needed and might be beneficial. The highest dose tested in the normal dogs was used in the heart failure dogs to maximize any potential blood volume redistribution that might occur.…”

Section: Discussionmentioning

confidence: 99%

“…The net result is a decrease in ventricular end-diastolic, atrial, venous, and capillary pressures, resulting in decreased edema formation. 5 Nitrate compounds have been shown to be effective and a safe means of producing vasodilation and blood volume redistribution in humans and thus are beneficial for patients with cardiac failure. 6,7 PO nitrate compounds may also be beneficial for dogs with refractory heart failure.…”

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confidence: 99%

“…Parameswaran et al 10 showed that nitroglycerin ointment transdermally administered to normal anesthetized dogs produced splenic venodilation, as evidenced by increases in splenic dimensions without increases in splenic venous pressure. Wang et al 5 showed that the intravenous administration of nitroglycerin to dogs with experimentally induced heart failure resulted in splanchnic venodilation. By simultaneously measuring splanchnic venous pressure and volume, they were able to demonstrate a rightward shift of the pressure-volume relation with nitroglycerin administration.…”

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Efficacy of a Single Oral Dose of Isosorbide 5-Mononitrate in Normal Dogs and in Dogs with Congestive Heart Failure

et al. 2001

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Isosorbide 5-mononitrate (5-ISMN) was evaluated in normal dogs and dogs with congestive heart failure (CHF) in a randomized, blinded, and placebo-controlled study. Equilibrium blood pool imaging was used to detect changes in regional blood volume distribution. Six normal dogs were administered placebo, 2, 3, and 4 mg/kg 5-ISMN PO on separate days with a 1-week washout period between randomized dosings. Six dogs with CHF were administered placebo or 4 mg/kg 5-ISMN on separate days with a 1-week washout period between randomized dosings. Data were collected at baseline and at 15, 30, 45, 60, 90, 120, 150, 180, 210, and 240 minutes after dosing. Measured variables included indirect arterial blood pressure (BP), heart rate (HR), packed cell volume (PCV), scintigraphic count rates for normal dogs, and scintigraphic count rates for CHF dogs. Blood for plasma 5-ISMN concentration determination was collected at 60 minutes. Scintigraphic counts were corrected for decay and expressed as a percentage of the whole. No differences were detected in BP, HR, PCV, thoracic blood volume percentage (TBVP), or abdominal blood volume percentage (ABVP) between placebo and 5-ISMN in normal dogs at any dose. No differences were detected in TBVP or ABVP between placebo and 5-ISMN in dogs with CHF. Plasma 5-ISMN concentration exceeded the minimum therapeutic concentration in all dogs and at all doses 60 minutes after drug administration. Equilibrium blood pool imaging failed to detect a shift in blood volume with oral 5-ISMN administration at any dose tested in normal dogs and dogs with CHF, despite adequate drug absorption. On the basis of the results of this study, 5-ISMN may not be beneficial in the treatment of dogs with CHF.Key words: Blood volume; Nitrates; Scintigraphy; Vasodilators.T herapy for congestive heart failure (CHF) in dogs most often includes a diuretic and an angiotensin-converting enzyme inhibitor, with or without digoxin. The objectives of therapy are to decrease circulating blood volume, decrease preload and afterload, enhance myocardial performance, and reduce fluid retention to improve quality of life. Patients often become refractory to standard heart failure therapy with time and progression of disease and so require additional therapeutic agents, such as direct acting vasodilators, for the control of edema.Nitrates are vasoactive substances that act primarily as systemic venodilators after oral or cutaneous administration. 1-4 Systemic venodilation increases systemic venous capacitance, shifting a portion of the circulating blood volume from the central circuit (ie, heart and pulmonary vasculature) to the systemic venous system. The net result is a decrease in ventricular end-diastolic, atrial, venous, and capillary pressures, resulting in decreased edema formation. 5 Nitrate compounds have been shown to be effective and a safe means of producing vasodilation and blood volume redistribution in humans and thus are beneficial for patients with cardiac failure. 6,7 PO nitrate compounds may also be beneficial for ...

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Splanchnic nerve modulation in heart failure: mechanistic overview, initial clinical experience, and safety considerations

Fudim

Ponikowski

Burkhoff

et al. 2021

European J of Heart Fail

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Volume recruitment from the splanchnic compartment is an important physiological response to stressors such as physical activity and blood loss. In the setting of heart failure (HF), excess fluid redistribution from this compartment leads to increased cardiac filling pressures with limitation in exercise capacity. Recent evidence suggests that blocking neural activity of the greater splanchnic nerve (GSN) could have significant benefits in some patients with HF by reducing cardiac filling pressures and improving exercise capacity. However, to date the long-term safety of splanchnic nerve modulation (SNM) in the setting of HF is unknown. SNM is currently used in clinical practice to alleviate some forms of chronic abdominal pain. A systematic review of the series where permanent SNM was used as a treatment for chronic abdominal pain indicates that permanent SNM is well tolerated, with side-effects limited to transient diarrhoea or abdominal colic and transient hypotension. The pathophysiological role of the GSN in volume redistribution, the encouraging findings of acute and chronic pilot SNM studies and the safety profile from permanent SNM for pain provides a strong basis for continued efforts to study this therapeutic target in HF.

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Splanchnic Venous Pressure–Volume Relation During Experimental Acute Ischemic Heart Failure

Cited by 40 publications

References 44 publications

A novel framework of circulatory equilibrium

A novel framework of circulatory equilibrium

Efficacy of a Single Oral Dose of Isosorbide 5-Mononitrate in Normal Dogs and in Dogs with Congestive Heart Failure

Splanchnic nerve modulation in heart failure: mechanistic overview, initial clinical experience, and safety considerations

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