Volume Status of Acute Heart Failure in Patients with Severe Left Ventricular Dysfunction with Mitral Regurgitation

By using a two-dimensional presentation of cardiac power index (Cpi) vs SVRI, Cotter et al found that acute heart failure syndromes (AHFS) can be accurately characterized hemodynamically. Exacerbated systolic CHF distributes through the limited area; SVRI ranges from 1600 to 4800dyne*sec*cm-5*m2 and Cpi from 0.2 to 0.6watt*m2. We made a hemodynamic assessment using this nomogram as well as estimating volume status in patients with severely depressed left ventricular systolic dysfunction with persistent severe mitral regurgitation (LVDwMR). Hemodynamic assessment and the measurement of thoracic fluid content (TFC) were performed by BioZ impedance cardiogram. We previously reported that TFC on admission (45±8/kOhm) is increased compared with control value (32±5/kOhm). Cardiac function was also determined using echocardiography. Five patients of LVDwMR were enrolled. MVP was operated in 4 of 5 patients later. Parameters of hemodynamics and cardiac function were as follows; BP=90±10mmHg, BNP=942±724pg/ml, LVDd=70±7mm, LVEF=25±7%, TRPG=54±15mmHg. Cpi (0.26±0.08) was severely depressed with increased SVRI (2657±726). However, the increase in TFC (36±5/kOhm) was mild. This mildness of the increase in TFC on admission in spite of severely depressed LV function with pulmonary hypertension suggests that the mechanism for the development of AHF in patients with LVDwMR is different from usual cardiac failure.