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LETTER TO THE EDITOR

Impact of Volume Loading on Systolic Mitral Annular Velocity (Sm) by Tissue Doppler Imaging

Ruggero Ama’, MD^*, Patrick Segers, PhD, Carl Roosens, MD^*, Tom Claessens, Pascal Verdonck, PhD, and Jan Poelaert, MD, PhD^*

*Department of ICU; Ghent University Hospital and International Research Center Hydraulics Laboratory; Institute Biomedical Technology; Ghent University; Ghent, Belgium; jan.poelaert{at}ugent.be

In Response:

We read with great interest Dr. Bendjelid’s comments about our published data (1). We fully agree nitroglycerine has a combined action on the venous and the arterial system in a dose-dependent manner. However, at the dose we used (300–500 µg IV), nitroglycerine has a predominant effect on systemic arterial resistance (2). It is generally accepted that the lack of an increase in stroke volume in response to nitrates is suggesting an insufficient dose to obtain a significant decrease in arterial impedance. This is true unless there is not a concomitant decrease in end-diastolic volume, which hampers a further increase in stroke volume (2–3). Therefore the simultaneous decrease in end-diastolic volume, stroke volume and mean arterial pressure (among with the changes in arterial elastance and resistance) as seen in our study indicates a decreased arterial load (1,3). Moreover, we analyzed even characteristic arterial impedance and compliance (Table 1) (data not shown in the original article), which indicated a significant decrease in afterload. If we consider afterload not as arterial load but as ventricular afterload, the concomitant decrease in end-systolic volume and mean arterial pressure, as seen in our study, demonstrates clearly a decrease in ventricular afterload. We therefore believe that our proposed physiological explanation of the described findings is valid.

References

1. Ama’ R, Segers P, Roosens C, et al. The effects of load on systolic mitral annular velocity by tissue Doppler imaging. Anesth Analg 2004;99:332–8.[Abstract/Free Full Text]
2. Parrillo JE. Vasodilator therapy. In: Chernow B, ed. The pharmacological approach to the critically ill patient. 3rd ed. Baltimore: Williams & Wilkins, 1994;470–83.
3. Chatterjee K, Parmley WW. The role of vasodilator therapy for chronic heart failure. Annu Rev Pharmacol Toxicol 1980;20:475–512.[Web of Science][Medline]

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