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Archives of cardiovascular diseases
Volume 106, n° 4
pages 258-259 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.036
Early changes in ventricular-arterial coupling in acutely decompensated systolic heart failure (ADSHF): An echocardiography and arterial tonometry study
 

E. Berthelot a, O. Masson b, N. Bihry b, A. Cohen-Solal b, P. Assayag a, D. Logeart b
a Hôpital Bicêtre, Le Kremlin Bicêtre, France 
b Hôpital Lariboisière, Paris, France 

Objectives .– Left ventricular (LV) performance is influenced by the coupled arterial and LV properties. Such properties have been poorly investigated during the real setting of acute HF. Our aim is to study the early change in ventricular-arterial coupling in patients with acutely decompensated systolic heart failure (ADSHF).

Patients and methods .– Patients hospitalized for ADSHF were screened. Shock, sustained arrhythmias and reversible HF were excluded. All patients were treated by IV loop diuretics; none received IV vasodilators or inotropes. ACE-I, ARB and betablockers were maintained using previous dose or half-dose. Echocardiography and radial artery tonometry (Sphygmocor, AtCor) were simultaneously performed on admission and were repeated after clinical stabilization (day 4±1). Ejection fraction (EF, Simpson rule), end-systolic volume (ESV), stroke volume (SV) and cardiac output (CO) were measured using echocardiography. From the reconstructed central aortic pressure, end-systolic pressure (Pes) and aortic pulse pressure (PP) were recorded. The SV/PP ratio quantified total arterial compliance and Pes/SV quantified the arterial elastance (Ea). End-systolic left ventricular elastance (Ees) was calculated by using the single-beat method.

Results .– Nineteen male patients (62±14years) were included. BNP decreased from 1813±1063 to 694±723pg/mL (P <0.01) and the weight loss was 4±2kg (P <0.01). The EF increased from 24±7% to 28±7% (P <0.02), SV increased from 23±6 to 27±7mL/m2 (P <0.01). ESV, CO and LV stroke work were unchanged (respectively 92±43 to 91±38mL/m2, 3.35±0.74 to 3.54±0.73L/min and 4599±1568 to 4752±1402mmHg/mL). Pes decreased from 104±17 to 89±15mmHg (P <0.01) but there was no change in PP (31±11 to 30±12mmHg). The total arterial compliance increased from 1.53±0.42 to 1.97±0.74mL/mmHg (P <0.01) and total peripheral resistance decreased from 2306±560 to 1863±644 dynes.s/cm5 (P <0.01); (P <0.01). There was a 29% decrease in Ea (2.57±0.89 to 1.82±0.52mmHg/mL, P <0.01). Ees was unchanged (from 1.27±0.41 to 1.15±0.39mmHg/mL). Consequently, the ratio Ea/Ees decreased from 2.16±0.76 to 1.81±0.44 (P <0.02).

Conclusion .– In ADSHF, early treatment mediated-hemodynamic changes are mainly characterized by a strong decrease in LV afterload, subsequent increase in LV ejection parameters and thus improvement in the ventricular -arterial coupling. In contrast, LV stroke work and contractility are poorly affected. Such an analysis is feasible and relevant for comprehensive hemodynamic assessment of acute HF.



© 2013  Published by Elsevier Masson SAS.
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