Hemodynamics in Daily Practice

240 Pages·1991·15.005 MB·English

by  Walter J. Paulus, Erik Andries (auth.), Erik Andries, Roland Stroobandt (eds.)

HEMODYNAMICS IN DAILY PRACTICE
HEMODYNAMICS
IN DAILY PRACTICE
ediud by
ERIK ANDRIES
Deparlme", 01 Cardio!ogy
OL V "ospilol. Aa/SI, Bdgium
aod
ROLANDSTROOBANDT
nep0rlmenr 0/ Cardiology
SI. JOZf'j Hospital. Ooslende. Be/gium
ForewQrd by
BEVERLY H. LORELL
HorJ,·tmf Medieal Seho,,1
SPRINGER SCIENCE+BUSINESS MEDIA, B.V.
Library of Congress Cataloging-in-Publication Data
Hemodynamics in daily practice / edited by E. Andries and R. Stroobandt.
p. cm. (Developments in cardiovascular medicine: 111)
ISBN 978-94-010-5698-4 ISBN 978-94-011-3820-8 (eBook)
DOI 10.1007/978-94-011-3820-8
1. Hemodynamic monitoring. 2. Heart-Pathophysiology.
I. Andries, E. (Erik) 11. Stroobandt, R. (Roland) III. Series
90-4260
RC670.5.H45H46 1990
616.1'20754-dc 20
ISBN 978-94-010-5698-4
Printed on acid-Jree paper
All Rights Reserved
© 1991 by Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1991
Softcover reprint of the hardcover 1s t edition 1991
No part of the material protected by this copyright notice may be reproduced or utilized in
any form or by any means, electronic or mechanical inc1uding photocopying, recording or by
any information storage and retrieval system, without written permission from the copyright
owner.
Table of contents
Foreword
Beverly H. Lorell VB
Preface
Erik Andries & Roland Stroobandt IX
List of authors and editors Xl
1. From hemodynamic principles to clinical management
Walter J. Paulus & Erik Andries
2. The clinical use and accuracy of echo-Doppler techniques for
assessing severity of disease in valvular stenotic lesions
Kenneth M. Borow, Alex Neumann, Daniel David & Roberto M.
Lang 21
3. Proper timing of valve replacement in aortic stenosis
Blase A. Carabello 43
4. Optimal timing of surgery for volume overload hypertrophy in
mitral and aortic regurgitation
Kenneth M. Borow 53
5. Acute effects of myocardial ischemia on left ventricular function:
How to differentiate myocardial infarction, stunned
myocardium, and hibernating myocardium
Guy R. Heyndrickx 77
6. Effects of coronary reperfusion on left ventricular function and
survival: Some remaining problems
Frans Van de Werf 91
7. Effects of revascularization on left ventricular function in the
stunned and hibernating myocardium
W. Flameng 101
Vl Contents
8. Heart failure: Newer concepts and origin of symptoms
Philip A. Poole-Wilson 113
9. Guidelines for the evaluation of treatment in congestive heart
failure
Wolfgang Kubler 129
10. Management of patients with hypertrophic cardiomyopathy
Robert o. Bonow, Barry J. Maron, Martin B. Leon, Richard O.
Cannon III & Stephen E. Epstein l37
II. Antiarrhytmic therapy in heart failure
Johannes Brachmann, Claus Schmitt, Thorsten Beyer, Bernd
Waldecker, Thomas Hilbel, Mark Schweizer & Wolfgang Kubler 159
12. Non-invasive evaluation of cardiomyopathies
Jos R. T. C. Roelandt, Folkert J. ten Cate & George R.
Sutherland 167
13. Can ultrasound reliably predict acute rejection in heart
transplant recipients?
H. F. J. Mannaerts, Jos R. T. C. Roelandt, George R.
Sutherland, A. H. M. M. Balk & J. H. Smyllie 185
14. Cardiac transplantation
F. Wellens 211
Subject index 225
Foreword
This book is an edited compilation of the scientific presentations given at
a symposium on cardiovascular hemodynamics and the contemporary practice
of cardiology which was organized in Malta, April 1989. The field of cardio
vascular medicine has undergone an extraordinary explosion of knowledge
regarding the basic biology of the heart and circulation in health and disease,
as well as technologic innovations for probing and assessing cardiac geometry
and physiology. This edition addresses such issues which are key problems
in current management of patients with heart disease. For example, the classic
notion that severe myocardial ischemia is invariably followd by either recovery
of normal function or the progression to cell death has been challenged by
experimental studies and clinical observations of patients undergoing throm
bolysis and revascularization. This growing body of observations clearly
indicates that the consequences of ischemia and reperfusion are much more
complex and variable, and include several states of abnormal metabolism and
contractile function which are distinct from either 'health' or 'death'. This
book presents current issues of both consensus and controversy regarding
the effects of myocardial ischemia and reperfusion, including irreversible cell
loss (infarction), myocardial stunning, and myocardial hibernation. Particular
attention is paid to the assessment and differentiation of such patients in
the coronary care unit, catheterization suite, or following surgical revascula
rization.
Secondly, this book addresses the hemodynamic evaluation of the patient
with valvular heart disease in today's cardiology practice. What are the
important differences in the pathophysiology of aortic stenosis versus regur
gitant valvular lesions? How does the assessment of loading conditions modify
the evaluation of left ventricular function in the patient with a depressed
ejection fraction? What are the consequences of valve replacement versus
percutaneous valvuloplasty? The importance of factors such as the type of
hypertrophic adaptation (pressure vs. volume overload resulting in concentric
vs. eccentric hypertrophy) are clearly presented. Building on this fresh synthesis
of current knowledge in the field, the authors develop contemporary invasive
E. Andries & R. Stroobandt (cds.), Hemodynamics in Daily Practice, vii-viii.
© 1991 Kluwer Academic Publishers, Dordrecht.
Vlll Foreword
and noninvasive approaches for the assessment of the severity of valvular
heart disease. The focus of these discussions is to maximally prepare today's
clinician for the difficult decision regarding the optimal timing of valve
replacement.
Third, this book addresses the problem of the clinical syndrome of heart
failure, which is a problem of increasing importance as the population becomes
more aged. The relevance and clinical implications of current basic science
knowledge regarding those intracellular processes that control myocardial
excitation-contraction coupling and metabolism, neurohumoral adaptations,
and receptor-second messenger coupling (including beta adrenergic receptor
down-regulation) are clearly discussed. At the nest level, current information
regarding the biologic basis and clinical discrimination of systolic versus
diastolic dysfunction as the physiologic basis for the clinical syndrome of
heart failure is presented. Included as a superb discussion of evolving concepts
regarding the pathophysiology and management of dilated and hypertrophic
cardiomyopathies. These considerations are developed into clear conceptual
and methodological approaches for the sophisticated and practical assessment
and treatment of patients with congestive heart failure. The authors also address
the evaluation and management of heart failure patients who are candidates
for or recipients of cardiac transplantation.
In summary, this book will prove to be stimulating and highly informative
during the first reading, and then be savored again and again as a reference.
This book invites the cardiology clinician who is already committed to
excellence in both scholarship and patient care to participate in an intimate
discussion with experts. For the reader, this volume will serve as a guide
for more expert and insightful hemodynamic assessment of the patient with
heart disease, and as a stimulus for future clinical investigations.
Beverly H. Lorell, M.D.
Harvard Medical School
Preface
This book aims at being a manual on hemodynamic problems for the practicing
clinician, who faces an ever increasing amount of information on cardiac
hemodynamics.
In the past few years extensive research resulted in the development of
important pathophysiological concepts, which have proven to be relevant for
correct patient care in different clinical settings.
With the advent of reliable non-invasive techniques such as echocardiogra
phy, Dopplerechocardiography and radio nuclide angiography, and also with
the widespread use of flow directed balloon catheters in the coronary care
unit, hemodynamic data can be obtained outside the catheterization laboratory.
Hemodynamic evaluation of left ventricular function revealed systolic and
diastolic etiologies of left ventricular failure in patients with coronary artery
disease, valvular heart disease and cardiomyopathies.
In the setting of valvular heart disease, concepts of pressure and volume
overload resulted in a clear understanding of adequate or inadequate adaptation
of the myocardium to the overload state and guided optimal timing for surgery.
The early effects of thrombolytic therapy on vessel patency have been
extensively studied but effects on left ventricular function need further
investigation.
Hypertrophic cardiomyopathy continues to be a subject of fascination and
frustration. Multiple pathophysiological mechanisms are operative mainly
consisting of impaired diastolic relaxation and in some patients of outflow
tract obstruction. Therapeutic interventions should be guided by assessment
of those mechanisms.
Major advances have been achieved in the pharmacological treatment of
congestive cardiomyopathy (unloading agents and new positive inotropic
drugs). Cardiac transplantation can be offered to the patient with endstage
disease.
E. Andries & R. Stroobandt (eds.), Hemodynamics in Daily Practice. ix-x.
© 1991 Kluwer Academic Publishers, Dordrecht.
x Preface
This book focuses on the clinical application of new hemodynamic patho
physiological concepts in daily practice. It is the result of a workshop organized
in Malta, April 1989.
The support of G. De Vriese, MD and his staff at leI Pharma in organizing
this symposium, is highly appreciated.
Erik Andries & Roland Stroobandt
List of authors and editors
Erik ANDRIES, MD
Department of Cardiology, O.L.V. Ziekenhuis, Moorselbaan, B-9300 Aalst, Belgium
Editor
Robert O. BONOW, MD
National Institute of Health, Building 10, Room 7B15, Bethesda, MD 20892, USA
Chapter 10 co-authors: Barry J. Maron, MD, Martin B. Leon, MD, Richard O. Cannon
III, MD and Stephen E. Epstein, MD
Kenneth M. BOROW, MD
Cardiac Noninvasive Physiology Laboratory, The University of Chicago Medical Center,
5841 S. Maryland Avenue, Box 44, Chicago, IL 60637, USA
Chapter 2 co-authors: Alex Neumann, BS, Daniel David, MD, Roberto M. Lang,
MD
Chapter 4
Johannes BRACHMANN, MD
Medizinische Klinik, Abteilung Innere Medizin III (Kardiologie), Medizinische Uni
versiteitsklinik, D-6900 Heidelberg, Germany
Chapter 10 co-authors: Claus Schmitt, Thorsten Beyer, Bernd Waldecker, Thomas
Hilbel, Mark Schweizer and Wolfgang Kubler
Blase A. CARABELLO, MD
Cardiology Division, Medical University of South Carolina, 171 Ashley Avenue,
Charleston, SC 29425, USA
Chapter 3
W. FLAMENG
Department of Cardiac Surgery, University Hospital Gasthuisberg, Herenstraat 49,
B-3000 Louvain, Belgium
Chapter 7
£. Andries & R. Stroobandt (eds.). Hemodynamics in Daily Practice, xi-xii.
© 1991 Kluwer Academic Publishers. Dordrecht.