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Right ventricular functional and hemodynamic effects of hydralazine and nitroprusside in chronic obstructive pulmonary disease
ABSTRACTS
PROSTACYCLIN THERAPY IN PATIENTS WITH CONGESTIVE HEART FAILURE Yoshiki Yui, MD; Hisayoshi Nakajima, MD; Chuichi Kawai, MD, FACC, Kyoto University Hospital, Kyoto, Japan. We studied the acute hemodynamic effects of intravenous prostacyclin, in doses of 27+15 ng/ kg/min (Mean?SD) in 10 patients with severe congestive heart failure refractory to diuretics and/or digitalis. After prostacyclin infusion, pulmonary capillary wedge pressure fell from 21.Ot11.4 mm Hg to 13.6t7.1 (P
Using high count rate first-pass radionuclide angiocardiography and pulmonary artery (PA) catheterfzation, the differential effects of the vasodilators, nitroprusside (N) and hydralazine (H), were compared in 6 patients (pts) with chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and abnormal (abnl) right ventricular (RV) function. All pts had nl left ventricular (LV) function. Measurements were made at 2 control states (Cl, CZ), after 0.5-lpg/kg/min N iv, and after 30-40mg H iv. Radionuclide RV and LV ejection fractions (EF,%),thermdilution cardiac index (Cl, l/min/n?) and mean PA pressure (MPAP,mmHg) were obtained i Pulmonary vascular resistance index (PVRI, dynes.sec*cm-5.m2) and RV end-diastolic volume index {(CO/heart rate)EF} (RVEDVI, ml/r?-) were derived. (Mean + SD; "pc.05; tpc.01 vs C). LVEF MPAP CI RVEF RVEDVI PVRI 2.8+.5 63+14 36+4 - 99+14 ~577+1a7 -34+a Cl 67716 79+9t 499+192t 27+7t 2.47.5* N 38+6 2.47.4 63+15 89+17 619+256 32+7 c2 37+4 4.1+.7t 74+13t H 45T6t 102T21 372+177t 32+9 H i&ced a major fail in PVRI (afterload) andsignificantly augmented RVEF, LVEF and CI. The increase in RVEF after H correlated inversely with the fall in PVRI (r=-0.86). In contrast, N predominantly decreased RVEDVI (preload), while PVRI and CI diminished minimally. RVBF did not change with N. Thus, afterload reduction with H improves biventricular performance in pts with COPD and cardiopulmonary compromise and appears to be the perferred therapy.
March 1982
The American Journal of CARDIOLOGY
PRESSURE GRADIENT AND CROSS SECTIONAL AREA STENOSIS IN PATIENTS WITH AND GIITHOUT EXERTIONAL ANGINA: WHAT IS A "CRITICAL STENOSIS?" P.W. Serruvs,Xl; J.H.C. Reiber,DhD; 11. Simoons, !!D; :l.van den Brand, MD; Thoraxcenter, Erasmus University, Rotterdam, The Netherlands. In order to evaluate what constitutes a ohysiologically significant obstruction to blood flow in the human coronary system, transstenotic (catheter 2,3,4.5F) mean pressure gradient (A?) normalized for mean aortic oressure (GP) and cross sectional area stenosis were correlated in 35 patients with an isolated obstruction in the left anterior descending artery or in the right coronarv artery. To quantitate true luminal cross sections of the stenotic lesions, a densitometric orocedure has been developed. Cineframes are analyzed with an image processing svstem. Video converted reTions of interest are digitized and the contours of a lesion detected automaticallv. Brightness levels are exnressed in terms of amounts of X-rav absorotion, allowing computation of %-densitometric area stenosis (%-A sten). When analyzing the relationship of droo pressure (AP/zP) to percent stenosis (%-A sten), minimal residual error and maximal coefficient of correlation (r=0.76) are achieved by an exnonential quation (y=O.O39eO*O2*x). When AP/Ti;;pis < 0.2 and A sten < 60%, all the patients (n=lO) are asymptomatic during maximal exercise test. When AP/zP is > 0.4 and A sten > 03% the pts (n=l5) always have exertional angina and their thallium myocardial scintizraohies are in all cases abnormal. In the group of pts (n=IO) with intermediate values of A? and A sten, the exercise test is nositif in six cases and negatif in four. Conclusion: by measuring transstenotic gradient and cross sectional area stenosis, it seems possible to identify at rest what constitutes a "critical stenosis" responsible for exertional angina yectoris.
THE SIGNIFICANCE OF PLATELET-VESSEL WALL PROSTAGLANDIN EQUILIBRIUM DURING EXERCISE-INDUCED STRESS Jawahar Mehta, MD, FACC; Paulette Mehta, MD, FACC; Christine Horalek, BS, C. Richard Conti, MD, FACC, University of Florida, Gainesville, Fla.
RIGHT VENTRICULAR FUNCTIONAL AND HEMODYNAMIC EFFECTS OF HYDRALAZINE AND NITROPRUSSIDE IN CHRONIC OBSTRUCTIVE PUtiONARY DISEASE Bruce Brent, MD; Harvey Berger, MD; Donald Mahler, MD; Richard Matthay, MD; Barry Zaret, MD, FACC, Yale University, New Haven, CT
926
MONDAY, APRIL 26, 1962 PM EXERCISE INDUCED STRESS 4:00-5: 15
Alterations in platelet-generated thromboxane A2 (TXA2) and vessel wall-generated prostacyclin (PGIp) have been associated with myocardial ischemia. To examine TXA2 PG12 equilibrium at rest and during exercise stress, we studied 13 normal subjects and 15 coronary artery disease patients. Plasma TXB2 and 6 ke'to PGFlc,were measured as stable metabolites of TXA2 and PG12, respectively, by radio-immunoassay. In normal subjects, plasma TXB2 levels increased 26% during exercise from 128 + 33 to 161 + 44 pg/ml (P-NS). Plasma 6 keto PGFla levels increased 268% from 47 + 18 to 173 + 57 pg/ml (PcO.05). In coronary artery disease patients, although resting plasma TXB2 levels (mean 133 + 33 pg/ml) were comparable to the normal subjects, a greater increase, 80%, occurred during exercise (mean 240 + 71 pg/ml, PcO.02 compared to resting levels). Resting plasma 6 keto PGFla levels (mean 87 + 30 pg/ml) were also similar to normal subjects, but increased only by 45% during exercise (mean 126 _?:54 pg/ ml, P-NS compared to resting levels). These data suggest that: 1) in normal subjects TXA2 and PGI2 increase during exercise, PGI2 increases more than TXA2; 2) although coronary disease patients have resting TXA2 and PGI2 levels in the normal range, TXA2 levels increase more than PG12 levels during exercise. These observations may have a bearing on the mechanism of exercise-induced angina pectoris in certain coronary artery disease patients..
Volume 49
PROSTACYCLIN THERAPY IN PATIENTS WITH CONGESTIVE HEART FAILURE Yoshiki Yui, MD; Hisayoshi Nakajima, MD; Chuichi Kawai, MD, FACC, Kyoto University Hospital, Kyoto, Japan. We studied the acute hemodynamic effects of intravenous prostacyclin, in doses of 27+15 ng/ kg/min (Mean?SD) in 10 patients with severe congestive heart failure refractory to diuretics and/or digitalis. After prostacyclin infusion, pulmonary capillary wedge pressure fell from 21.Ot11.4 mm Hg to 13.6t7.1 (P
Using high count rate first-pass radionuclide angiocardiography and pulmonary artery (PA) catheterfzation, the differential effects of the vasodilators, nitroprusside (N) and hydralazine (H), were compared in 6 patients (pts) with chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and abnormal (abnl) right ventricular (RV) function. All pts had nl left ventricular (LV) function. Measurements were made at 2 control states (Cl, CZ), after 0.5-lpg/kg/min N iv, and after 30-40mg H iv. Radionuclide RV and LV ejection fractions (EF,%),thermdilution cardiac index (Cl, l/min/n?) and mean PA pressure (MPAP,mmHg) were obtained i Pulmonary vascular resistance index (PVRI, dynes.sec*cm-5.m2) and RV end-diastolic volume index {(CO/heart rate)EF} (RVEDVI, ml/r?-) were derived. (Mean + SD; "pc.05; tpc.01 vs C). LVEF MPAP CI RVEF RVEDVI PVRI 2.8+.5 63+14 36+4 - 99+14 ~577+1a7 -34+a Cl 67716 79+9t 499+192t 27+7t 2.47.5* N 38+6 2.47.4 63+15 89+17 619+256 32+7 c2 37+4 4.1+.7t 74+13t H 45T6t 102T21 372+177t 32+9 H i&ced a major fail in PVRI (afterload) andsignificantly augmented RVEF, LVEF and CI. The increase in RVEF after H correlated inversely with the fall in PVRI (r=-0.86). In contrast, N predominantly decreased RVEDVI (preload), while PVRI and CI diminished minimally. RVBF did not change with N. Thus, afterload reduction with H improves biventricular performance in pts with COPD and cardiopulmonary compromise and appears to be the perferred therapy.
March 1982
The American Journal of CARDIOLOGY
PRESSURE GRADIENT AND CROSS SECTIONAL AREA STENOSIS IN PATIENTS WITH AND GIITHOUT EXERTIONAL ANGINA: WHAT IS A "CRITICAL STENOSIS?" P.W. Serruvs,Xl; J.H.C. Reiber,DhD; 11. Simoons, !!D; :l.van den Brand, MD; Thoraxcenter, Erasmus University, Rotterdam, The Netherlands. In order to evaluate what constitutes a ohysiologically significant obstruction to blood flow in the human coronary system, transstenotic (catheter 2,3,4.5F) mean pressure gradient (A?) normalized for mean aortic oressure (GP) and cross sectional area stenosis were correlated in 35 patients with an isolated obstruction in the left anterior descending artery or in the right coronarv artery. To quantitate true luminal cross sections of the stenotic lesions, a densitometric orocedure has been developed. Cineframes are analyzed with an image processing svstem. Video converted reTions of interest are digitized and the contours of a lesion detected automaticallv. Brightness levels are exnressed in terms of amounts of X-rav absorotion, allowing computation of %-densitometric area stenosis (%-A sten). When analyzing the relationship of droo pressure (AP/zP) to percent stenosis (%-A sten), minimal residual error and maximal coefficient of correlation (r=0.76) are achieved by an exnonential quation (y=O.O39eO*O2*x). When AP/Ti;;pis < 0.2 and A sten < 60%, all the patients (n=lO) are asymptomatic during maximal exercise test. When AP/zP is > 0.4 and A sten > 03% the pts (n=l5) always have exertional angina and their thallium myocardial scintizraohies are in all cases abnormal. In the group of pts (n=IO) with intermediate values of A? and A sten, the exercise test is nositif in six cases and negatif in four. Conclusion: by measuring transstenotic gradient and cross sectional area stenosis, it seems possible to identify at rest what constitutes a "critical stenosis" responsible for exertional angina yectoris.
THE SIGNIFICANCE OF PLATELET-VESSEL WALL PROSTAGLANDIN EQUILIBRIUM DURING EXERCISE-INDUCED STRESS Jawahar Mehta, MD, FACC; Paulette Mehta, MD, FACC; Christine Horalek, BS, C. Richard Conti, MD, FACC, University of Florida, Gainesville, Fla.
RIGHT VENTRICULAR FUNCTIONAL AND HEMODYNAMIC EFFECTS OF HYDRALAZINE AND NITROPRUSSIDE IN CHRONIC OBSTRUCTIVE PUtiONARY DISEASE Bruce Brent, MD; Harvey Berger, MD; Donald Mahler, MD; Richard Matthay, MD; Barry Zaret, MD, FACC, Yale University, New Haven, CT
926
MONDAY, APRIL 26, 1962 PM EXERCISE INDUCED STRESS 4:00-5: 15
Alterations in platelet-generated thromboxane A2 (TXA2) and vessel wall-generated prostacyclin (PGIp) have been associated with myocardial ischemia. To examine TXA2 PG12 equilibrium at rest and during exercise stress, we studied 13 normal subjects and 15 coronary artery disease patients. Plasma TXB2 and 6 ke'to PGFlc,were measured as stable metabolites of TXA2 and PG12, respectively, by radio-immunoassay. In normal subjects, plasma TXB2 levels increased 26% during exercise from 128 + 33 to 161 + 44 pg/ml (P-NS). Plasma 6 keto PGFla levels increased 268% from 47 + 18 to 173 + 57 pg/ml (PcO.05). In coronary artery disease patients, although resting plasma TXB2 levels (mean 133 + 33 pg/ml) were comparable to the normal subjects, a greater increase, 80%, occurred during exercise (mean 240 + 71 pg/ml, PcO.02 compared to resting levels). Resting plasma 6 keto PGFla levels (mean 87 + 30 pg/ml) were also similar to normal subjects, but increased only by 45% during exercise (mean 126 _?:54 pg/ ml, P-NS compared to resting levels). These data suggest that: 1) in normal subjects TXA2 and PGI2 increase during exercise, PGI2 increases more than TXA2; 2) although coronary disease patients have resting TXA2 and PGI2 levels in the normal range, TXA2 levels increase more than PG12 levels during exercise. These observations may have a bearing on the mechanism of exercise-induced angina pectoris in certain coronary artery disease patients..
Volume 49