PMID- 22974796
OWN - NLM
STAT- MEDLINE
DCOM- 20130205
LR  - 20161125
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 5
IP  - 9
DP  - 2012 Sep
TI  - Loss of adrenergic augmentation of diastolic intra-LV pressure difference in 
      patients with diastolic dysfunction: evaluation by color M-mode echocardiography.
PG  - 861-70
LID - 10.1016/j.jcmg.2012.05.013 [doi]
AB  - OBJECTIVES: The aim of this study was to evaluate the hypothesis that the 
      adrenergic response of the intraventricular pressure difference (IVPD) is reduced 
      in patients with preserved ejection fraction (EF) and diastolic dysfunction (DD). 
      BACKGROUND: In early diastole, there is a progressive IVPD extending from the 
      left atrium (LA) to the left ventricular (LV) apex. In response to adrenergic 
      stimulation, as occurs during exercise, the IVPD increases allowing rapid filling 
      without an abnormal increase in LA pressure. Patients with heart failure with a 
      reduced EF have impaired adrenergic augmentation of the IVPD. METHODS: We studied 
      166 consecutive patients undergoing dobutamine stress echocardiography who had no 
      inducible ischemia and an EF >/=50%, of which 21 had normal diastolic function, 14 
      had impaired relaxation (grade 1), 80 had pseudonormal filling (grade 2), and 51 
      had restrictive filling (grade 3). Color M-mode Doppler (CMMD) images of mitral 
      inflow were obtained at rest and during low (10 mug/kg/min) and peak (20 to 40 
      mug/kg/min) doses of dobutamine. The total IVPD from the LA to LV apex, LA to 
      mid-LV, and mid-LV to the LV apex were calculated using the CMMD data to 
      integrate the Euler equation. RESULTS: Total IVPD was not different between 
      groups at rest. With dobutamine, the total IVPD increased by 2.20 +/- 1.95 mm Hg in 
      normal subjects and by only 0.73 +/- 1.33 mm Hg, 1.84 +/- 1.63 mm Hg, and 1.08 +/- 1.57 
      mm Hg in patients with grades 1, 2, and 3 DD, respectively. This difference was 
      due to a failure in augmentation of IVPD from the mid-LV to the LV apex, 
      indicating reduced apical ventricular suction with DD, whereas the IVPD from the 
      LA to the mid-LV responded similarly to dobutamine in normal subjects and those 
      with DD. CONCLUSIONS: In patients with preserved EF, DD is associated with a 
      reduced adrenergic augmentation of the IVPD from the mid-LV to the LV apex, 
      reflecting less apical suction.
CI  - Copyright (c) 2012 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Ohara, Takahiro
AU  - Ohara T
AD  - Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North 
      Carolina 27157-1045, USA.
FAU - Niebel, Cassie L
AU  - Niebel CL
FAU - Stewart, Kelley C
AU  - Stewart KC
FAU - Charonko, John J
AU  - Charonko JJ
FAU - Pu, Min
AU  - Pu M
FAU - Vlachos, Pavlos P
AU  - Vlachos PP
FAU - Little, William C
AU  - Little WC
LA  - eng
GR  - HL106276-01A1/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Adrenergic Agonists)
RN  - 3S12J47372 (Dobutamine)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2012 Sep;5(9):871-3. PMID: 22974797
MH  - *Adrenergic Agonists
MH  - Adult
MH  - Aged
MH  - Analysis of Variance
MH  - *Diastole
MH  - *Dobutamine
MH  - *Echocardiography, Doppler, Color
MH  - *Echocardiography, Stress
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Stroke Volume
MH  - Ventricular Dysfunction, Left/*diagnostic imaging/physiopathology
MH  - *Ventricular Function, Left
MH  - *Ventricular Pressure
EDAT- 2012/09/15 06:00
MHDA- 2013/02/06 06:00
CRDT- 2012/09/15 06:00
PHST- 2012/05/08 00:00 [received]
PHST- 2012/05/08 00:00 [revised]
PHST- 2012/05/21 00:00 [accepted]
PHST- 2012/09/15 06:00 [entrez]
PHST- 2012/09/15 06:00 [pubmed]
PHST- 2013/02/06 06:00 [medline]
AID - S1936-878X(12)00534-7 [pii]
AID - 10.1016/j.jcmg.2012.05.013 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2012 Sep;5(9):861-70. doi: 10.1016/j.jcmg.2012.05.013.