PREDICTION OF THE CHANGES IN CARDIAC-OUTPUT IN ASSOCIATION WITH PRELOAD REDUCTION THERAPY IN PATIENTS WITH HYPERTENSIVE HEART-FAILURE

In treating patients with acute hypertensive heart failure we often tr y preload-reduction therapy using diuretics or vasodilators, but this may frequently produce a considerable decrease in cardiac output, part icularly in hypertensive patients with diastolic dysfunction. Therefor e, it is important from the clinical standpoint to predict the change in cardiac output following preload-reduction therapy. The objective o f this study was to assess whether the change in cardiac output in ass ociation with preload-reduction therapy is predictable before treatmen t by analysis of mitral flow velocity patterns in patients with hypert ensive heart failure. Changes in left ventricular volumes and cardiac output in association with preload-reduction therapy and Doppler echoc ardiographic parameters of the mitral flow velocity pattern before tre atment were studied in 18 patients with hypertensive heart failure. Ca rdiac output increased in six patients with systolic dysfunction (frac tional shortening <25%). In the other 12 patients (those with normal s ystolic function), the changes in cardiac output were homogenous among the patients. In this subset there was a greater decrease in cardiac output in patients with a shorter deceleration time. Thus, analysis of deceleration time of the early diastolic filling wave before treatmen t may be useful in estimating the change in cardiac output following p reload reduction in patients with hypertensive heart failure due to di astolic dysfunction.