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      Doppler Diastolic Transmitral Flow Patterns in Severe Heart Failure: Response to Controlled Changes in Filling Pressure Using Intravenous Isosorbide Dinitrate

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          Serial Doppler diastolic transmitral flow patterns were compared with simultaneous hemodynamic measurements in a homogeneous group of patients with severe (New York Heart Association class 4) heart failure who were receiving high dose (508 ± 271 µg/min) intravenous isosorbide dinitrate. The Doppler tracing uniformly showed a severe restrictive pattern, with tall peak early diastolic filling (E) wave (84 ± 12 cm/s), small late filling (A) wave (28 ± 8 cm/s) and very high E/A ratio (3.2 ± 0.8). Isosorbide dinitrate decreased wedge pressure and systemic vascular resistance by a third and increased cardiac index by more than 40%. Transmitral Doppler E/A ratio changed directly in relation to the changes in pulmonary capillary wedge (r = 0.85, p = 0.03) and right atrial pressure (r = 0.84, p = 0.03), indicating preload dependence of transmitral flow velocity, even in severe heart failure.

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          Author and article information

          S. Karger AG
          18 November 2008
          : 85
          : 3-4
          : 235-243
          Cardiovascular Research Unit, Department of Cardiology, Lady Davis Carmel Hospital, Haifa, Israel
          176681 Cardiology 1994;85:235–243
          © 1994 S. Karger AG, Basel

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          Page count
          Pages: 9
          Clinical Pharmacology


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