The Effects of β-Adrenergic Stimulation on the Length-Dependent Regulation of Myocardial Function in Coronary Surgery Patients

Hert, S. G. De; Linden, P J van der; Broecke, Pieter W. ten; Rodrigus, Inez; Sermeus, Luc; Moulijn, Adriaan C.; Gillebert, Thierry C.

doi:10.1097/00000539-199910000-00005

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…These findings are consistent with previous reports showing increased diastolic myocardial performance and enhanced myocardial relaxation during β‐adrenergic stimulation in healthy subjects (10, 12, 13, 31, 32). Similar effects and improved ventricular function have been seen in coronary surgery patients with preserved left ventricular performance (33). Conversely, impaired diastolic performance has been shown to be an early sign of dobutamine‐induced myocardial ischemia following myocardial infarction (34) and before percutaneous coronary angioplasty (10, 11).…”

Section: Discussionsupporting

confidence: 62%

MR flow mapping of dobutamine‐induced changes in diastolic heart function

Paelinck

Lamb

Bax

et al. 2004

Magnetic Resonance Imaging

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Purpose:To evaluate the ability of MR flow mapping to measure changes in left ventricular filling during ␤-adrenergic stimulation. Materials and Methods:Mitral flow was measured in 10 healthy volunteers using conventional free breathing fastfield echo (FFE) with a spatial resolution of 2.7 ϫ 2.2 mm and a temporal resolution of 22 msec. The sequence was repeated during dobutamine infusion (20 g/kg/minute).Results: Stroke volume increased from a median of 99 mL (range: 68 -142 mL) (Note: values as presented are medians and ranges, throughout) to 114 mL (87-180 mL) (P Ͻ 0.05). Both early (E) peak filling rate (554 mL/second [433-497 mL] to 651 mL/second [496 -1096 mL/second]) (P Ͻ 0.05) and atrial (A) peak filling rate (238 mL/second [183-352 mL/second] to 341 mL/second [230 -538 mL/second]) (P Ͻ 0.05) increased. These changes, together with the increase in E acceleration peak and A deceleration peak, were consistent with facilitated myocardial relaxation. Conclusion:Conventional free breathing FFE has the ability to measure the effects of ␤-adrenergic stimulation on left ventricular filling.

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Section: Discussionsupporting

confidence: 62%

MR flow mapping of dobutamine‐induced changes in diastolic heart function

Paelinck

Lamb

Bax

et al. 2004

Magnetic Resonance Imaging

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“…The evidence to support the use of one inotrope over another has not been rigorously studied and choice is often made on the basis of a more favourable side-effect profile 154,155 , a profile which is dose-dependant. Impairment of diastolic relaxation is a common feature after separation of CPB 156 and recently both dobutamine and milrinone have been shown to have favourable effects on the rate of myocardial relaxation post-CPB 157,158 resulting in improved diastolic and systolic cardiac performance. For this reason dobutamine is viewed by many as a favourable initial inotropic therapy.…”

Section: Levosimendan In Cardiac Surgerymentioning

confidence: 99%

Inoprotection: The Perioperative Role of Levosimendan

Royse

et al. 2007

Anaesth Intensive Care

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Levosimendan is emerging as a novel cardioprotective inotrope. Levosimendan augments myocardial contractility by sensitising contractile myofilaments to calcium without increasing myosin adenosine triphosphatase activity or oxygen consumption. Levosimendan activates cellular adenosine triphosphate-dependent potassium channels, a mechanism which is postulated to protect cells from ischaemia in a manner similar to ischaemic preconditioning. Levosimendan may therefore protect the ischaemic myocardium during ischaemia-reperfusion as well as improve the contractile function of the heart. Adenosine triphosphate-dependent potassium channel activation by levosimendan may also be protective in other tissues, such as coronary vascular endothelium, kidney and brain. Clinical trials in patients with decompensated heart failure and myocardial ischaemia show levosimendan to improve haemodynamic performance and potentially improve survival. This paper reviews the known pharmacology of levosimendan, the clinical experience with the drug to date and the potential use of levosimendan as a cardioprotective agent during surgery.

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“…At least 10 consecutive beats were taken for the calculation of R. Sample correlation coefficients of the end‐systolic pressure –τ relationships yielded values of r > 0.92 in all patients. Previous reports have indicated that such analysis provides accurate information on systolic and diastolic function and allows assessment of the functional reserve capacity of the left ventricle under various circumstances [15–22]. Arterial and mixed venous blood samples were taken before and 5 min after haemodilution and analysed for calculation of oxygen transport and related variables.…”

Section: Methodsmentioning

confidence: 99%

Effects of moderate acute isovolaemic haemodilution on myocardial function in patients undergoing coronary surgery under volatile inhalational anaesthesia

Hert¹,

Cromheecke²,

Lorsomradee³

et al. 2009

Anaesthesia

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SummaryWhen myocardial oxygen demand is increased by elevated heart rate in patients undergoing coronary artery surgery under total intravenous anaesthesia, acute isovolaemic haemodilution may be associated with a deterioration of cardiac function. We investigated the effects of acute isovolaemic haemodilution during volatile inhalational anaesthesia. Forty patients undergoing coronary surgery were randomly assigned to two groups according to the rate of atrioventricular pacing (Group 70 at 70.min )1 and Group 90 at 90.min )1 ). While paced at the fixed heart rate, acute isovolaemic haemodilution was performed before the start of cardiopulmonary bypass. In both groups mean (SD) stroke volume increased with haemodilution (from 65 (9) to 83 (10) ml.min )1 (p < 0.01) in Group 70 and from 65 (9) to 81 (9) ml.min

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The Effects of β-Adrenergic Stimulation on the Length-Dependent Regulation of Myocardial Function in Coronary Surgery Patients

Abstract: This study demonstrated that beta-adrenoreceptor stimulation with dobutamine improved length-dependent regulation of myocardial function assessed during leg elevation in cardiac surgical patients.

Cited by 5 publications

References 15 publications

MR flow mapping of dobutamine‐induced changes in diastolic heart function

MR flow mapping of dobutamine‐induced changes in diastolic heart function

Inoprotection: The Perioperative Role of Levosimendan

Effects of moderate acute isovolaemic haemodilution on myocardial function in patients undergoing coronary surgery under volatile inhalational anaesthesia

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