Amrinone and exercise performance in patients with chronic heart failure

Weber, Karl T.; Andrews, Virginia; Janicki, Joseph S.; Wilson, John R.; Fishman, Alfred P.

doi:10.1016/0002-9149(81)90586-5

Cited by 102 publications

(21 citation statements)

References 18 publications

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“…Over the past 3 years, we have performed hundreds of maximal exercise tests without incident. Many of our patients have been evaluated serially in the course of studying the efficacy of various pharmacologic modes of management.8 22 The determination of V02 max has proved valuable in assessing the severity of cardiac failure, the aerobic and functional capacities of each patient, and the natural course of their disease. However, we have consistently excluded from our studies patients in whom maximal exercise testing would clearly be hazardous.…”

Section: Discussionmentioning

confidence: 99%

Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure.

Weber¹,

Kinasewitz²,

Janicki³

et al. 1982

Circulation

873

373

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SUMMARY Muscular work requires the integration of cardiopulmonary mechanisms for gas exchange and 02 delivery. In patients with chronic cardiac failure, the response of these mechanisms may be impaired, and the pattern of 02 utilization (VO2) and gas exchange during exercise would thus provide an objective assessment of the severity of heart failure. Accordingly, rates of air flow, 0, uptake, CO, elimination and minute ventilation were determined during progressive treadmill exercise in 62 patients with stable heart failure. Exercise cardiac output, systemic 0, extraction and lactate production were measured directly in 40 patients with heart failure of varying severity. As the severity of heart failure increased from class A to D, there was a progressive decrease in exercise capacity (from 1157 4 154 to 373 ± 157 seconds) and maximum VO, (23 ± 3.1 to 8.4 ± 1.5 ml/min/kg). These decreases corresponded with the reduced maximum cardiac output and stroke volume during exercise. The appearance of anaerobic metabolism (580 ± 17 to 157 ± 7 seconds of exercise) and the corresponding anaerobic threshold (17 ± 0.34 to 7.1 i 1.5 ml/min/kg), determined noninvasively, were reproducible and correlated with the rise in mixed venous lactate concentration. No apparent untoward effects were experienced during or after the progressive exercise test. We conclude that the measurement of respiratory gas exchange and air flow during exercise is an objective, reproducible and safe noninvasive method for characterizing cardiac reserve and functional status in patients with chronic cardiac failure.AT REST, patients with heart disease often display normal cardiac performance. To elicit an abnormality in ventricular function, a physiologic stress, such as exercise, is required. This concept is well recognized clinically, when the severity of cardiac failure is traditionally evaluated in terms of information that relates levels of exertion with the appearance of breathlessness or fatigue. A more quantitative approach based on the pathophysiologic response to progressive exercise would be valuable for assessing the severity of cardiac disease and the functional capacity.Muscular work elicits a complex interplay of diverse physiologic mechanisms designed to ensure that 02 delivery is commensurate with 02 demand. The heart, lung and 02 carrying capacity of the blood participate in these adjustments. In patients with heart disease, cardiac output may not rise appropriately during exercise. The 02 delivery system is then compromised, and the aerobic capacity is thus reduced. Determination of 02 utilization during exercise, measured by the collection of expired air, provides an objective assessment of functional capacity in normal subjects and in patients with valvular heart disease.1-4 However, enthusiasm for using this method to evaluate patients with chronic failure irrespective of cause and severity is tempered by the relative uncertainty of correlating respiratory gas exchange with cardiac function, the perceived hazards of exposing the pat...

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Section: Discussionmentioning

confidence: 99%

Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure.

Weber¹,

Kinasewitz²,

Janicki³

et al. 1982

Circulation

873

373

View full text Add to dashboard Cite

show abstract

“…4.1 [7], due to an increase in O 2 consumption, with both increase in VO 2 and O 2 extraction by skeletal muscle. However, anaerobic metabolism occurs at this "critical" SvO 2 , which also corresponds to the O 2 tissue extraction limit (or critical extraction).…”

Section: Mixed Venous Oxygen Saturation (Svo 2 )mentioning

confidence: 99%

Monitoring the Adequacy of Oxygen Supply and Demand

Giraud

Bendjelid

2016

Hemodynamic Monitoring in the ICU

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“…Amrinone is a positive inotropic agent which favorably alters hemodynamics in patients with congestive heart failure (1)(2)(3)(4)(5)(6). Along with its inotropic action, the vasodilatory property of amrinone may con tribute to the increase in cardiac output in these patients (1,2,6).…”

mentioning

confidence: 99%

Involvement of Cyclic AMP in Vasodilatation by Amrinone: A Comparative Study with 3-Isobutyl-1-Methyl-Xanthine (IBMX)

Kishi

Numano

1986

Japanese Journal of Pharmacology

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Abstract-We investigated the effect of amrinone, a non-glycosidic, non-adrenergic cardiotonic drug, on rabbit aortic strips and vascular smooth muscle cells cultured from rabbit aorta. Amrinone relaxed the strips precontracted by KCI, norepinephrine, serotonin or STA2 in a dose-dependent manner, and it shifted the dose-response curves downward.A similar mode of relaxation was noted with IBMX, an inhibitor of cyclic AMP phosphodiesterase (cAMPPDE). Although propranolol did not affect the relaxation induced by amrinone, W-7, a calmodulin antagonist, slightly potentiated and IBMX attenuated the response.In intact smooth muscle cells in culture, amrinone increased basal levels of cAMP and markedly potentiated cAMP accumulation in response to 10-6 M isoproterenol. The effect on cAMP accumu lation mimicked that of IBMX but the effects were not additive.Inhibition of cAMPPDE was also demonstrated in a cell-free system, IC50 values for amrinone and IBMX being 2

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Amrinone and exercise performance in patients with chronic heart failure

Cited by 102 publications

References 18 publications

Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure.

Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure.

Monitoring the Adequacy of Oxygen Supply and Demand

Involvement of Cyclic AMP in Vasodilatation by Amrinone: A Comparative Study with 3-Isobutyl-1-Methyl-Xanthine (IBMX)

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