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Wyatt HL, Da Luz PL, Waters DD, et al. Contrasting influences of alterations in ventricular preload and afterload upon systemic hemodynamics, function, and metabolism of ischemic myocardium. Circulation. 1977;55(2):318-24doi: 10.1161/01.cir.55.2.318.
Wyatt, H. L., Da Luz, P. L., Waters, D. D., Swan, H. J., & Forrester, J. S. (1977). Contrasting influences of alterations in ventricular preload and afterload upon systemic hemodynamics, function, and metabolism of ischemic myocardium. Circulation, 55(2), 318-24. https://doi.org/10.1161/01.cir.55.2.318
Wyatt, H L, et al. "Contrasting influences of alterations in ventricular preload and afterload upon systemic hemodynamics, function, and metabolism of ischemic myocardium." Circulation vol. 55,2 (1977): 318-24. doi: https://doi.org/10.1161/01.cir.55.2.318
Wyatt HL, Da Luz PL, Waters DD, Swan HJ, Forrester JS. Contrasting influences of alterations in ventricular preload and afterload upon systemic hemodynamics, function, and metabolism of ischemic myocardium. Circulation. 1977 Feb;55(2):318-24. doi: 10.1161/01.cir.55.2.318. PMID: 832348.
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Circulation. 1977 Feb;55(2):318-24. doi: 10.1161/01.cir.55.2.318.

Contrasting influences of alterations in ventricular preload and afterload upon systemic hemodynamics, function, and metabolism of ischemic myocardium.

Circulation

H L Wyatt, P L Da Luz, D D Waters, H J Swan, J S Forrester

PMID: 832348 DOI: 10.1161/01.cir.55.2.318

Abstract

This study of anesthetized, open-chest dogs compares the effects of primary increases in left ventricular preload and afterload upon global and regional myocardial function and metabolism in the presence of a left anterior descending coronary artery stenosis (LAD). When LAD flow was reduced to 40-50% of control, regional systolic shortening declined by 20 to 25% and regional lactate extraction changed to production. In seven control dogs the mechanical abnormalities persisted during the 30 min of observation, but lactate production was reduced spontaneously. In ten dogs, increases in left ventricular end-diastolic pressure (LVEDP) during dextran infusion were associated with increases in cardiac output and regional systolic shortening; however, regional lactate production also increased (P less than 0.05) despite an augmentation in LAD flow. In seven dogs mean arterial pressure increased by an average of 32 mm Hg during angiotensin infusion (0.2 to 0.4 mug/kg/min); LVEDP did not change but cardiac output decreased significantly. LAD artery flow improved markedly and lactate production shifted to extraction (P less than 0.05) while systolic shortening remained unchanged. When angiotensin was discontinued, lactate extraction worsened again. Thus, in the presence of a severe coronary stenosis, a primary increase in preload improves cardiac output but at the expense of aggravated ischemia. In contrast, a primary increase in afterload reduces cardiac output but may improve perfusion and lactate uptake of the ischemic myocardium.

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