Comparative responses to dobutamine and nitroprusside in patients with chronic low output cardiac failure.

Berkowitz, Cary E.; McKeever, Louis S.; Croke, R P; Jacobs, W R; Loeb, Henry S.; Gunnar, R M

doi:10.1161/01.cir.56.6.918

Cited by 61 publications

(14 citation statements)

References 19 publications

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“…In such patients it is unlikely that a reduction in ventricular size and wall tension during dobutamine infusion, which might occur in patients with advanced congestive heart failure, would offset the increased myocardial oxygen demand associated with the chronotropic and inotropic effects of dobutamine. 8 Consistent with this expectation, our 14 patients showed a significant increase in resting MVO during dobutamine infusion, and although only three patients developed chest pain, the group as a whole demonstrated evidence of ischemia as indicated by a significant reduction in mean MLEx and an increase in ST segment depression. Although coronary blood flow increased substantially during dobutamine infusion, it is possible that this increase in flow was primarily to regions supplied by unobstructed vessels.…”

Section: Discussionsupporting

confidence: 82%

Effects of low-dose dobutamine on coronary hemodynamics, myocardial metabolism, and anginal threshold in patients with coronary artery disease.

Pacold¹,

Kleinman²,

Gunnar³

et al. 1983

Circulation

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Fourteen patients with coronary artery disease and normal or near-normal left ventricular function were studied at rest and during atrial pacing until the occurrence of angina (12 patients) before and during infusion of dobutamine (3.80 + 0.45 ,ug/kg/min). At rest, during the infusion, three patients developed chest pain, mean ST segment depression increased from 0.02 to 0.08 mV (p < .001), and myocardial lactate extraction fell from + 17.5% to -1.4% (p < .05). These ischemic changes were associated with significant increases in arterial systolic pressure (134 to 149 mm Hg), heart rate (79 to 91 beats/min), coronary sinus flow (89 to 113 ml/min) and myocardial oxygen consumption (10.8 to 13.5 cc/min). In contrast, during atrial pacing, dobutamine did not reduce the pacing threshold or further increase myocardial oxygen consumption or ST segment changes; however, arterial mean and diastolic pressures were significantly lower with pacing during dobutamine infusion compared with control pacing. In the absence of heart failure, dobutamine in low doses can cause myocardial ischemia in patients with coronary artery disease. The absence of increased ischemia from dobutamine during pacing may reflect reversal of pacing-induced ventricular dysfunction. Circulation 68, No. 5, 1044-1050, 1983. BECAUSE of its relative lack of direct chronotropic and peripheral-vascular effects, dobutamine has become a popular inotropic agent for temporary support of cardiac patients with acute hypotension and lowoutput states, even when left ventricular function is only modestly impaired. Such patients frequently have had recent myocardial infarction or coronary artery surgery. Thus the effects of dobutamine on the balance between myocardial oxygen supply and demand in patients with coronary artery disease are of clinical importance. The purpose of our study was to evaluate the effects of dobutamine infusion on coronary hemodynamics and myocardial metabolism both at rest and during rapid atrial pacing in a group of patients with significant coronary disease who nevertheless had normal or only modest impairment of left ventricular function. MethodsPatients were selected for the study on the basis of a clinical diagnosis of angina pectoris and angiographic demonstration of 1044significant coronary obstruction (>50% transluminal diameter) of at least one major coronary artery. Patients with unstable angina, significant left main coronary artery obstruction, myocardial infarction within the preceeding 6 weeks, severe heart failure (New York Heart Association class III or IV), or significant valvular heart disease were excluded. The study group was selected from the patients with angina pectoris who were referred to our cardiac catheterization laboratory for coronary angiography. The study group consisted of 14 patients who met all the inclusion criteria and who consented to participate in the study. The study was done 1 to 21 days (mean 8 days) after coronary angiography. f3-Adrenoreceptor blocking agents were discontinued for 48 h...

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Section: Discussionsupporting

confidence: 82%

Effects of low-dose dobutamine on coronary hemodynamics, myocardial metabolism, and anginal threshold in patients with coronary artery disease.

Pacold¹,

Kleinman²,

Gunnar³

et al. 1983

Circulation

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“…In an attempt to find a sympathomimetic amine with a selective positive inotropic activity, the agent dobutamine (Dobutrex, Lilly, Windles, England) has been synthesized [40]. Although dobutamine has been studied extensively in adults [1,2,9,17,18,21,24,29,41,43,45], experience with this agent in newborns is limited [28, 36,]. Confirmation of the efficacy of dobutamine in newborns seems to be necessary since there are well-known differences in the performance of the myocardium between newborns and adults [3,7,8,12,26,[31][32][33]43].…”

Section: Offprint Requests To: H Stopfkuchenmentioning

confidence: 99%

Effects of dobutamine on left ventricular performance in newborns as determined by systolic time intervals

et al. 1987

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To evaluate the effects of dobutamine on myocardial function in newborns, left ventricular systolic time intervals (STI) - normalized pre-ejection period (PEPI), normalized left ventricular ejection time (LVETI) and pre-ejection period to left ventricular ejection time ratio (PEP/LVET) - were assessed by echocardiography in 18 newborns treated with dobutamine for clinically diagnosed heart failure. Examinations were performed prior to and 30 min after starting dobutamine infusion (7.5 or 10 micrograms/kg per min). Patients were assigned to two groups according to their PEP/LVET prior to dobutamine administration: group I (n = 9) with pre-treatment PEP/LVET less than or equal to 0.35 and group II (n = 9) with pre-treatment PEP/LVET greater than 0.35. While there was no change of STI in group I, dobutamine infusion resulted in a significant decrease in PEPI (from 102 +/- 4.8 to 87.8 +/- 4.2; mean +/- SEM; P less than 0.01) and of PEP/LVET (from 0.56 +/- 0.05 to 0.45 +/- 0.05; mean +/- SEM; P less than 0.01) and in a significant increase of LVETI (from 237.6 +/- 5.6 to 253.3 +/- 5.2; mean +/- SEM; P less than 0.01) in group II. Heart rate increased significantly in both groups. Left ventricular end-diastolic dimension, also assessed by echocardiography, did not change in the eight studies performed. An increase in mean arterial pressure was found in three out of five newborns of group II and in one out of four patients in group I. It is concluded that dobutamine can improve cardiac performance in newborns with impaired left ventricular function. This effect is probably due to an improvement in myocardial contractility.

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“…In adults the following hemodynamic effects of dobutamine were observed: Increase of myocardial contractility with little chronotropic effect and little effect on the pulmonary and systemic vascular resistances [1,4,5,8,9]. Although dobutamine has been studied extensively in adults, little is known about its effect in children [2,6,7,11].…”

Section: Dobutamine 1 Was Developed By Tuttle and Millsmentioning

confidence: 99%

Hemodynamic effects of dobutamine in children with cardiovascular failure

et al. 1982

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Abstract. The effect of dobutamine, a synthetic catecholamine, was studied in 12 patients aged one day to 14 years with low cardiac output syndromes.After initial Stabilization of the patients dobutamine was administered by continuous infusion in a dosage of 7.5 or 10/~g/kg/min.Heart rate, cardiac output (using thermodilution technique and/or pulse contour method), mean systemic and mean pulmonary artery pressures were determined before and after the dobutamine infusion. Systemic and pulmonary vascular resistances, cardiac index and stroke volume index were calculated.Cardiac output and cardiac index increased significantly in every patient, whereas the heart rate changed only slightly, suggesting that the increase in cardiac output was mainly due to the alteration of stroke volume. The mean arterial pressure increased significantly, but the mean pulmonary artery pressure was unchanged. No side effects were observed during the dobutamine infusion. Dobutamine is a potent inotropic drug with limited chronotropic and peripheral vascular effects in newborns, infants and children.

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Comparative responses to dobutamine and nitroprusside in patients with chronic low output cardiac failure.

Cited by 61 publications

References 19 publications

Effects of low-dose dobutamine on coronary hemodynamics, myocardial metabolism, and anginal threshold in patients with coronary artery disease.

Effects of low-dose dobutamine on coronary hemodynamics, myocardial metabolism, and anginal threshold in patients with coronary artery disease.

Effects of dobutamine on left ventricular performance in newborns as determined by systolic time intervals

Hemodynamic effects of dobutamine in children with cardiovascular failure

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