Intravenous sodium nitroprusside significantly reduced left ventricular end-diastolic pressure (19 to 11 mm Hg) and mean pulmonary artery pressure (39 to 25 mm Hg; P<0.001 for both) in severe AS.
Does intravenous sodium nitroprusside improve hemodynamics in symptomatic patients with hypertension and low-gradient severe aortic stenosis with preserved ejection fraction?
Vasodilator therapy with nitroprusside in patients with low-gradient severe aortic stenosis, preserved ejection fraction, and hypertension effectively reduces LV filling pressures and pulmonary artery pressures while increasing aortic valve area.
valor p: p=<0.001
BACKGROUND: Low-gradient severe aortic stenosis with preserved ejection fraction is an increasingly recognized entity, and symptomatic patients may benefit from aortic valve replacement. However, systemic hypertension frequently coexists with low-gradient severe aortic stenosis, which itself may cause elevated left ventricular (LV) filling pressures with resultant symptoms of dyspnea. METHODS AND RESULTS: Symptomatic patients with hypertension (aortic systolic pressure >140 mm Hg) and low-gradient (mean gradient 50%) who underwent invasive hemodynamic catheterization of the left and right sides of the heart received infusion of intravenous sodium nitroprusside to reduce blood pressure and arterial afterload. At baseline, patients had severe hypertension (aortic systolic pressure, 176±26 mm Hg), pulmonary hypertension (mean pressure, 39±12 mm Hg), elevated LV end-diastolic pressure (19±5 mm Hg), and reduced stroke volume (33±8 mL/m(2)). All measures of afterload were reduced with nitroprusside (P<0.001 for all). Nitroprusside reduced mean pulmonary artery pressure (25±10 mm Hg) and LV end-diastolic pressure (11±5 mm Hg; P<0.001 for both compared with baseline). Aortic valve area (0.86±0.11 to 1.02±0.16 cm(2); P=0.001) and mean gradient (27±5 to 29±6 mm Hg; P=0.02) increased with nitroprusside. CONCLUSIONS: Systemic hypertension in low-gradient severe aortic stenosis with preserved ejection fraction is associated with elevated LV filling pressures and pulmonary hypertension. Treatment of hypertension with vasodilator therapy results in a lowering of the total LV afterload, with a decrease in LV filling pressures and pulmonary artery pressures. These findings have important implications for the management of patients with low-gradient severe aortic stenosis with preserved ejection fraction and hypertension.
Eleid et al. (Sat,) conducted a other in Low-gradient severe aortic stenosis with preserved ejection fraction and systemic hypertension. Intravenous sodium nitroprusside vs. Baseline was evaluated on Hemodynamic parameters including left ventricular end-diastolic pressure and mean pulmonary artery pressure (p=<0.001). Intravenous sodium nitroprusside significantly reduced left ventricular end-diastolic pressure (19 to 11 mm Hg) and mean pulmonary artery pressure (39 to 25 mm Hg; P<0.001 for both) in severe AS.