Impact of short-term intermittent intravenous dobutamine therapy on endothelial function in patients with severe chronic heart failure

Freimark, Dov; Feinberg, Micha S.; George‐Levi, Sivan; Hochberg, Naomi; Shechter, Michael

doi:10.1016/j.ahj.2004.04.013

Cited by 22 publications

(13 citation statements)

References 24 publications

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“…5,[15][16][17][18][19][20][21] Briefly, FMD was assessed in the subject's right arm in the recumbent position in a temperaturecontrolled room (22°C) after a 10-minute equilibration period by a single ultrasonographer blinded to the subject's clinical status. Using a 15-6 MHz linear array (15-6L HP) ultrasound (HP SON0S 7500 CV system; Agilent Technologies Inc., Andover, MA, USA), the brachial artery was longitudinally imaged approximately 5 cm proximal to the antecubital crease.…”

Section: Vascular Function Protocolmentioning

confidence: 99%

Pulse pressure is a predictor of vascular endothelial function in middle-aged subjects with no apparent heart disease

et al. 2010

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Elevated pulse pressure (PP) is increasingly being recognized as a cardiovascular risk factor. To investigate whether PP is associated with endothelial function in subjects with no apparent heart disease we prospectively assessed brachial flowmediated dilation (FMD) in 525 consecutive subjects with no apparent heart disease [323 (61%) men, mean age 52 ± 11 years, mean body mass index (BMI) 26 ± 4 kg/m 2 ]. Following an overnight fast and discontinuation of all medications for ≥ 12 hours, the FMD and endothelium-independent, nitroglycerin-mediated vasodilation (NTG) were assessed using highresolution linear array ultrasound. Univariate linear analysis revealed a significant inverse association between FMD and PP (r = -0.65, p < 0.01), systolic blood pressure (r = -0.52, p < 0.01) and age (r = -0.21, p < 0.05). Multivariate analysis showed that PP was the strongest independent predictor of FMD. We therefore divided the study population into two groups: group A (n = 290) ≤ the median PP, and group B (n = 235) > the median PP of 50 mmHg. Male sex, hypertension, diabetes, BMI, heart rate, and the use of aspirin, long-acting nitrates, calcium channel blockers, angiotensin-converting enzyme inhibitors and beta blockers were significantly more common in Group B compared with Group A. FMD but not NTG was significantly greater in patients with PP ≤ the median PP, compared with > the median PP (14.9 ± 7.9% vs 10.8 ± 8.8%, p < 0.001 and 16.1 ± 9.6% vs 14.8 ± 8.4%, p = 0.38; respectively). Thus, PP is inversely associated with brachial FMD in middle-aged subjects with no apparent heart disease, suggesting a potential mechanism whereby elevated PP contributes to cardiovascular disease. Long-term follow-up is warranted to elucidate the incidence of coronary artery disease in both study groups.

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Section: Vascular Function Protocolmentioning

confidence: 99%

Pulse pressure is a predictor of vascular endothelial function in middle-aged subjects with no apparent heart disease

et al. 2010

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“…A growing number of reports have demonstrated the close relationship between endothelial function and NEI network: (1) Endothelial function in patients with severe chronic heart failure can be improved by DA [17], suggesting that neurotransmitters may play a key role in the pathogenesis of endothelial dysfunction; (2) AngII can lead to endothelial dysfunction via AngII receptor subtypek 1 activation and reactive oxygen- and nitrogen species generation [18]; (3) L-thyroxine therapy can improve endothelial function in the subclinical hypothyroidism patients [19]; (4) CRH can induce a significant increase of ET-1 release [20]; (5) Endothelial dysfunction occurring in the metabolic syndrome is the result of effects of the inflammatory cytokine TNF-α and subsequent production of superoxide [21,22]. The studies mentioned above indicated that NEI network has a tight connection with endothelial function.…”

Section: Discussionmentioning

confidence: 99%

Expression Profile of Neuro-Endocrine-Immune Network in Rats with Vascular Endothelial Dysfunction

Jia

et al. 2014

Korean J Physiol Pharmacol

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This study was to determine the correlation between endothelial function and neuro-endocrine-immune (NEI) network through observing the changes of NEI network under the different endothelial dysfunction models. Three endothelial dysfunction models were established in male Wistar rats after exposure to homocysteine (Hcy), high fat diet (HFD) and Hcy+HFD. The results showed that there was endothelial dysfunction in all three models with varying degrees. However, the expression of NEI network was totally different. Interestingly, treatment with simvastatin was able to improve vascular endothelial function and restored the imbalance of the NEI network, observed in the Hcy+HFD group. The results indicated that NEI network may have a strong association with endothelial function, and this relationship can be used to distinguish different risk factors and evaluate drug effects.

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“…In chronic heart failure patients, dobutamine increases cardiac output and improves tissue perfusion, which leads to improvement of endothelial function and tissue oxygenation. It was demonstrated that short-term (72 hours) and short-term intermittent (for five hours, biweekly) administration of dobutamine has a sustained beneficial effect on vascular endothelial function for two weeks or longer and after four months, respectively [25,26]. Despite this effect of dobutamine on endothelial function in patients with chronic heart failure, we have not detected any difference in StO 2 deoxygenation in our mixed population of patients with left heart failure and additional sepsis/septic shock treated with or without dobutamine.…”

Section: Discussionmentioning

confidence: 99%

Near-infrared spectroscopy during stagnant ischemia estimates central venous oxygen saturation and mixed venous oxygen saturation discrepancy in patients with severe left heart failure and additional sepsis/septic shock

Možina

Podbregar

2010

Critical Care

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IntroductionDiscrepancies of 5-24% between superior vena cava oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) have been reported in patients with severe heart failure. Thenar muscle tissue oxygenation (StO2) measured with near-infrared spectroscopy (NIRS) during arterial occlusion testing decreases slower in sepsis/septic shock patients (lower StO2 deoxygenation rate). The StO2 deoxygenation rate is influenced by dobutamine. The aim of this study was to determine the relationship between the StO2 deoxygenation rate and the ScvO2-SvO2 discrepancy in patients with severe left heart failure and additional sepsis/septic shock treated with or without dobutamine.MethodsFifty-two patients with severe left heart failure due to primary heart disease with additional severe sepsis/septic shock were included. SvO2 and ScvO2 were compared to the thenar muscle StO2 before and during arterial occlusion.ResultsSvO2 correlated significantly with ScvO2 (Pearson correlation 0.659, P = 0.001), however, Bland Altman analysis showed a clinically important difference between both variables (ScvO2-SvO2 mean 72 ± 8%, ScvO2-SvO2 difference 9.4 ± 7.5%). The ScvO2-SvO2 difference correlated with plasma lactate (Pearson correlation 0.400, P = 0.003) and the StO2 deoxygenation rate (Pearson correlation 0.651, P = 0.001). In the group of patients treated with dobutamine, the ScvO2-SvO2 difference correlated with plasma lactate (Pearson correlation 0.389, P = 0.011) and the StO2 deoxygenation rate (Pearson correlation 0.777, P = 0.0001).ConclusionsIn patients with severe heart failure with additional severe sepsis/septic shock the ScvO2-SvO2 discrepancy presents a clinical problem. In these patients the skeletal muscle StO2 deoxygenation rate is inversely proportional to the difference between ScvO2 and SvO2; dobutamine does not influence this relationship. When using ScvO2 as a treatment goal, the NIRS measurement may prove to be a useful non-invasive diagnostic test to uncover patients with a normal ScvO2 but potentially an abnormally low SvO2.Trial RegistrationNCT00384644 ClinicalTrials.Gov.

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Impact of short-term intermittent intravenous dobutamine therapy on endothelial function in patients with severe chronic heart failure

Cited by 22 publications

References 24 publications

Pulse pressure is a predictor of vascular endothelial function in middle-aged subjects with no apparent heart disease

Pulse pressure is a predictor of vascular endothelial function in middle-aged subjects with no apparent heart disease

Expression Profile of Neuro-Endocrine-Immune Network in Rats with Vascular Endothelial Dysfunction

Near-infrared spectroscopy during stagnant ischemia estimates central venous oxygen saturation and mixed venous oxygen saturation discrepancy in patients with severe left heart failure and additional sepsis/septic shock

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