EFFECTS OF VASODILATORS ON PULMONARY VENOUS AND MITRAL FLOW VELOCITY PATTERNS IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

To characterize abnormalities in pulmonary venous flow velocity patter ns and to explore the changes in these patterns following short-term ( 3 to 14 days) administration of vasodilators, pulmonary venous and mit ral flow velocity patterns were serially studied at congestive heart f ailure and after vasodilator administration in 18 patients. Peak mitra l early diastolic filling velocity (E) and the ratio of E to peak fill ing velocity at atrial contraction (E/A) consistently decreased after vasodilator administration by 30 +/- 4 cm/s and 0.74 +/- 0.13 (mean +/ - SD), respectively. Peak pulmonary venous diastolic forward flow velo city also decreased by 29 +/- 4 cm/s. However, changes in peak pulmona ry venous systolic forward flow velocity (S, cm/s) did not correlate w ith changes in E, the E/A ratio, or D (peak pulmonary venous diastolic forward flow velocity). Thus, when patients were divided into two gro ups on the basis of changes in of left ventricular systolic performanc e, such as end-systolic dimension and fractional shortening, improved more in the group which showed an increase in S after vasodilator admi nistration than in the group which showed a decrease in S (-7 +/- 6 vs - 1 +/- 4 mm, p<0.05; 8 +/- 6 vs - 1 +/- 4%, p<0.05). Although the mi tral flow velocity pattern changed uniformly with vasodilator administ ration in patients with mild to moderate congestive heart failure, the changes in pulmonary venous flow velocity patterns were not uniform a mong patients. Pulmonary venous flow velocity patterns appear to refle ct changes in left ventricular systolic performance in addition to tho se in left ventricular diastolic performance.