Effects of Blood Volume Expansion on Left Ventricular Hemodynamics in Man

Abstract

The hemodynamic effects of acute blood volume expansion with low molecular-weight dextran were studied in 11 normal patients and 18 patients with coronary artery disease free of angina at the time of study and without evidence of heart failure. In the coronary artery disease group 350 ml (range 130-540 ml) was infused at the rate of 26.7 ml/min (range 19-36 ml/min). There was an increase in left ventricular end-diastolic pressure (LVEDP) from 10.3 to 18.7 mm Hg, brachial artery mean pressure (BAm) from 102 to 105 mm Hg, pulse pressure (PP) from 56.7 to 63.2 mm Hg, cardiac index (CI) from 3.1 to 3.8 liters/min/m ² , stroke index (SI) from 37 to 44 ml/m ² , and left ventricular stroke-work index (LVSWI) from 46 to 53 g-m/m ² . There was no change in heart rate. In normal subjects, 387 ml (range 200-480 ml) was infused at the rate of 26.4 ml/min (range. 15-37 ml/min). There was an increase in LVEDP from 8.0 to 18.4 mm Hg, PP from 55.5 to 66.8 mm Hg, CI from 3.2 to 4.0 liters/min/m ² , SI from 38 to 46 ml/m ² , and LVSWI from 46 to 54 g-m/m ² . Heart rate and BAm were unchanged. LVEDP increased to abnormal levels in every subject and was associated with small increases in SI and LVSWI. In the absence of myocardial ischemia the challenge of an acute volume did not differentiate left ventricular performance of patients with coronary artery disease from normal subjects.