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Pulsus alternans induced by inferior vena caval occlusion in man.

Publication ,  Journal Article
Bashore, TM; Walker, S; Van Fossen, D; Shaffer, PB; Fontana, ME; Unverferth, DV
Published in: Cathet Cardiovasc Diagn
1988

To assess the effect of rapid preload reduction on left ventricular performance in nonischemic cardiomyopathy, 11 patients were studied during inferior vena caval (IVC) balloon occlusion. Five developed sustained pulsus alternans. During pulsus alternans, the strong beats demonstrated systolic performance characteristics similar to baseline values, despite a drop in both left ventricular (LV) end-diastolic diameter (66 +/- 13 to 61 +/- 13 mm; p less than 0.05) and LV end-diastolic pressure (21 +/- 8 to 9 +/- 6 mmHg; p less than 0.05). In contrast, the weak beats demonstrated a reduction in peak systolic pressure (130 +/- 36 to 109 +/- 33 mmHg; p less than 0.02), fractional shortening (20% +/- 4% to 17% +/- 9%; p less than 0.05) and peak positive dP/dt (1,006 +/- 224 to 921 +/- 287 mmHg; p less than 0.05). Measures of diastolic performance (peak negative dP/dt, the time constant of LV relaxation, the length of diastasis, and LV end-diastolic stress) were not different between baseline beats and the strong beats; and only LV end-diastolic stress differed when baseline beats were compared to the weak beats. When the strong beats were compared to the weak beats during induced pulsus alternans, significant differences were observed in peak systolic pressure, peak positive dP/dt, and fractional shortening, but no differences in any measured diastolic parameter was observed. A slight difference was noted in the left ventricular end-diastolic diameters, with the weak beat consistently beginning at a slightly smaller diameter (61 +/- 13; mm vs 59 +/- 13; p less than 0.05). In summary, these data are consistent with an augmentation and deletion of intrinsic contractile forces in association with an alternation in preload on a beat-to-beat basis as best describing left ventricular performance during pulsus alternans.

Duke Scholars

Published In

Cathet Cardiovasc Diagn

DOI

ISSN

0098-6569

Publication Date

1988

Volume

14

Issue

1

Start / End Page

24 / 32

Location

United States

Related Subject Headings

  • Vena Cava, Inferior
  • Pulse
  • Myocardial Contraction
  • Male
  • Humans
  • Female
  • Echocardiography
  • Constriction
  • Catheterization
  • Cardiovascular System & Hematology
 

Citation

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Bashore, T. M., Walker, S., Van Fossen, D., Shaffer, P. B., Fontana, M. E., & Unverferth, D. V. (1988). Pulsus alternans induced by inferior vena caval occlusion in man. Cathet Cardiovasc Diagn, 14(1), 24–32. https://doi.org/10.1002/ccd.1810140106
Bashore, T. M., S. Walker, D. Van Fossen, P. B. Shaffer, M. E. Fontana, and D. V. Unverferth. “Pulsus alternans induced by inferior vena caval occlusion in man.Cathet Cardiovasc Diagn 14, no. 1 (1988): 24–32. https://doi.org/10.1002/ccd.1810140106.
Bashore TM, Walker S, Van Fossen D, Shaffer PB, Fontana ME, Unverferth DV. Pulsus alternans induced by inferior vena caval occlusion in man. Cathet Cardiovasc Diagn. 1988;14(1):24–32.
Bashore, T. M., et al. “Pulsus alternans induced by inferior vena caval occlusion in man.Cathet Cardiovasc Diagn, vol. 14, no. 1, 1988, pp. 24–32. Pubmed, doi:10.1002/ccd.1810140106.
Bashore TM, Walker S, Van Fossen D, Shaffer PB, Fontana ME, Unverferth DV. Pulsus alternans induced by inferior vena caval occlusion in man. Cathet Cardiovasc Diagn. 1988;14(1):24–32.

Published In

Cathet Cardiovasc Diagn

DOI

ISSN

0098-6569

Publication Date

1988

Volume

14

Issue

1

Start / End Page

24 / 32

Location

United States

Related Subject Headings

  • Vena Cava, Inferior
  • Pulse
  • Myocardial Contraction
  • Male
  • Humans
  • Female
  • Echocardiography
  • Constriction
  • Catheterization
  • Cardiovascular System & Hematology