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Weberling LD, Seitz S, Salatzki J, Ochs A, Heins J, Haney AC, Siry D, Frey N, André F, Steen H. Safety of dobutamine or adenosine stress cardiac magnetic resonance imaging in patients with left ventricular thrombus. Clin Res Cardiol 2024; 113:446-455. [PMID: 37843560 PMCID: PMC10881726 DOI: 10.1007/s00392-023-02317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Left ventricular (LV) thrombus formation is a common but potentially serious complication, typically occurring after myocardial infarction. Due to perceived high thromboembolic risk and lack of safety data, stress cardiac magnetic resonance (CMR) imaging especially with dobutamine is usually avoided despite its high diagnostic yield. This study aimed to investigate the characteristics, safety and outcome of patients with LV thrombus undergoing dobutamine or vasodilator stress CMR. METHODS Patients undergoing stress CMR with concomitant LV thrombus were retrospectively included. Risk factors, comorbidities, and previous embolic events were recorded. Periprocedural safety was assessed for up to 48 h following the examination. Major adverse cardiac events (MACE) 12 months before the diagnosis were compared to 12 months after the exam and between patients and a matched control group. Additionally, patients were followed up for all-cause mortality. RESULTS 95 patients (78 male, 65 ± 10.7 years) were included. Among them, 43 patients underwent dobutamine (36 high-dose, 7 low-dose) and 52 vasodilator stress CMR. Periprocedural safety was excellent with no adverse events. During a period of 24 months, 27 MACE (14.7%) occurred in patients and controls with no statistical difference between groups. During a median follow-up of 33.7 months (IQR 37.6 months), 6 deaths (6.3%) occurred. Type of stress agent, thrombus mobility, or protrusion were not correlated to embolic events or death. CONCLUSION The addition of a stress test to a CMR exam is safe and does increase the generally high cardioembolic event rate in LV thrombus patients. Therefore, it is useful to support reperfusion decision-making.
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Affiliation(s)
- Lukas D Weberling
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
| | | | - Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Andreas Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Jannick Heins
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Ailís C Haney
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Deborah Siry
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Henning Steen
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Ruíz-López P, Schauvliege S, Gasthuys F, Haspeslagh M. Dobutamine use in horses during romifidine and isoflurane anaesthesia. Res Vet Sci 2024; 167:105119. [PMID: 38154415 DOI: 10.1016/j.rvsc.2023.105119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
This retrospective study aimed to assess the incidence of hypotension and the subsequent administration of dobutamine in horses anesthetized with isoflurane and romifidine during elective surgery. Time from induction of anaesthesia to administration of dobutamine was registered, as well as the time and dose needed to restore mean arterial pressure (MAP) ≥ 70 mmHg. Additionally, the influence of patient and anaesthesia related parameters on the need for dobutamine supplementation was evaluated. In total, 118 horses were included in this retrospective study. Dobutamine was administered to effect when MAP<70 mmHg. Data registered: patient weight, acepromazine premedication, body position, administration of intraoperative ketamine bolus, locoregional anaesthesia, mechanical ventilation, duration of anaesthesia, dose and duration of dobutamine administration, heart rate, MAP before dobutamine administration, MAP and time required to increase MAP≥70 mmHg. Dobutamine infusion was needed in 54.2% of the horses 30 ± 17 min after isoflurane-romifidine anaesthesia started. Dobutamine 0.55 ± 0.18 μg kg-1 min-1 achieved a MAP≥70 mmHg in 12 ± 8 min. Duration of dobutamine infusion was 56 ± 37 min. An univariable logistic regression showed a significant association between dobutamine and acepromazine administration (p = 0.01; OR = 3.43), anaesthesia time (p = 0.02; OR = 2.41) and dorsal recumbency (p < 0.001; OR = 8.40). In a multivariable logistic regression, only dorsal recumbency significantly increased the need for dobutamine supplementation (p < 0.001; OR = 7.70). There was no significant association between patient weight (p = 0.11; OR = 1), locoregional anaesthesia (p = 0.07; OR = 0.47), administration of a ketamine bolus (p = 0.95; OR = 0.98) or volume controlled ventilation (p = 0.94; OR = 1.04) and dobutamine administration. Low doses of dobutamine were suitable to restore MAP above 70 mmHg within a limited time period. Only dorsal recumbency increased the need of dobutamine administration.
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Affiliation(s)
- Patricia Ruíz-López
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - Stijn Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Frank Gasthuys
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Maarten Haspeslagh
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, 9820 Merelbeke, Belgium
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Ismail H, Gabriels JK, Chang D, Donnelly J, Kim BS, Epstein LM, Hentz R, Fishbein J, Huang X, Kowalski M, Dasrat P, Rahyab AS, Goldner B. Site-specific effects of dobutamine on cardiac conduction and refractoriness. J Interv Card Electrophysiol 2024; 67:71-82. [PMID: 37227538 DOI: 10.1007/s10840-023-01573-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Isoproterenol, a non-specific beta agonist, is commonly used during electrophysiology studies (EPS). However, with the significant increase in the price of isoproterenol in 2015 and the increasing number of catheter ablations performed, the cost implications cannot be ignored. Dobutamine is a less expensive synthetic compound developed from isoproterenol with a similar mechanism to enhance cardiac conduction and shorten refractoriness, thus making it a feasible substitute with a lower cost. However, the use of dobutamine for EPS has not been well-reported in the literature. OBJECTIVE To determine the site-specific effects of various doses of dobutamine on cardiac conduction and refractoriness and assess its safety during EPS. METHODS From February 2020 to October 2020, 40 non-consecutive patients scheduled for elective EPS, supraventricular tachycardia, atrial fibrillation, and premature ventricular contraction ablations at a single center were consented and prospectively enrolled to assess the effect of dobutamine on the cardiac conduction system. At the end of each ablation procedure, measures of cardiac conduction and refractoriness were recorded at baseline and with incremental doses of dobutamine at 5, 10, 15, and 20 mcg/kg/min. For the primary analysis, the change per dose of dobutamine from baseline to each dosing level of dobutamine received by the patients, comparing atrioventricular node block cycle length (AVNBCL), ventricular atrial block cycle length (VABCL) and sinus cycle length (SCL), was tested using mixed-effect regression. For the secondary analysis, dobutamine dose level was tested for association with relative changes from baseline of each electrophysiologic parameter (SCL, AVNBCL, VABCL, atrioventricular node effective refractory period (AVNERP), AH, QRS, QT, QTc, atrial effective refractory period (AERP), ventricular effective refractory period (VERP), using mixed-effect regression. Changes in systolic and diastolic blood pressures were also assessed. The Holm-Bonferroni method was used to adjust for multiple testing. RESULTS For the primary analysis there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to each dose level of dobutamine. The SCL, AVNBCL, VABCL, AVNERP, AERP, VERP and the AH, and QT intervals all demonstrated a statistically significant decrease from baseline to at least one dose level with incremental dobutamine dosing. Two patients (5%) developed hypotension during the study and one patient (2.5%) received a vasopressor. Two patients (5%) had induced arrhythmias but otherwise no major adverse events were noted. CONCLUSION In this study, there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to any dose level of dobutamine. As expected, the AH and QT intervals, and the VABCL, VERP, AERP and AVNERP all significantly decreased from baseline to at least one dose level with an escalation in dobutamine dose. Dobutamine was well-tolerated and safe to use during EPS.
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Affiliation(s)
- Haisam Ismail
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - James K Gabriels
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - David Chang
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Joseph Donnelly
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Beom Soo Kim
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Laurence M Epstein
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Roland Hentz
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Joanna Fishbein
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Xueqi Huang
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Marcin Kowalski
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Parmanand Dasrat
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Ali Seyar Rahyab
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Bruce Goldner
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA.
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Bahloul M, Kharrat S, Bouchaala K, Chtara K, Bouaziz M. Takotsubo cardiomyopathy following scorpion envenomation: a literature review. Am J Cardiovasc Dis 2023; 13:354-362. [PMID: 38205067 PMCID: PMC10774618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Takotsubo syndrome is comparable to microvascular acute coronary syndrome. It may partly share the same pathophysiology debated during scorpion envenomation (SE), with an adrenergic storm, without myocardial infarction due to the absence of coronary artery stenosis. Takotsubo cardiomyopathy can help to better understand the pathophysiology of cardiac involvement during scorpion envenomation. However, Takotsubo syndrome seems to be underestimated in the literature in patients suffering from cardiac failure following SE. METHODS In this review, we aimed to detail all described cases, the mechanism, and outcomes of scorpion envenomation complicated by Takotsubo cardiomyopathy. We used the PubMed database by using the following keywords in MeSH research: scorpion envenomation, Takotsubo cardiomyopathy, and Takotsubo syndrome. RESULTS The literature analysis showed the existence of only four cases of confirmed Takotsubo cardiomyopathy following severe SE. All four patients developed a transient reversible left ventricular systolic dysfunction in the absence of coronary artery disease, following a positive history of scorpion envenomation. A cardiac MRI was performed in all cases, showing a ballooning in the left ventricle associated with a left ventricular ejection fraction in all cases. All patients were improved under symptomatic treatment, and complete recovery of the wall motion was observed. CONCLUSION Takotsubo syndrome, although not often reported in the literature in severe SE, can represent an effective hypothesis explaining the pathophysiology of cardiac involvement during SE. In severe scorpion envenomation, multiple mechanisms exist and can explain the development of Takotsubo syndrome. Its management is based on oxygen, with invasive or non-invasive ventilator support in patients with respiratory failure and/or cardiogenic shock. Beta-blockers, mineralocorticoid receptor antagonists, and diuretics are usually used in Takotsubo syndrome. However, in severe scorpion envenomation, all reported cases of Takotsubo cardiomyopathy are associated with cardiogenic shock and acute pulmonary edema. As a consequence, we advise the use of Dobutamine since it has already been confirmed that cardiac dysfunction following scorpion envenomation improves well and safely under Dobutamine infusion.
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Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University Sfax, Tunisia
| | - Sana Kharrat
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University Sfax, Tunisia
| | - Karama Bouchaala
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University Sfax, Tunisia
| | - Kamilia Chtara
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax University Sfax, Tunisia
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Lanser CNG, van Poecke WHA, Scheffers LE, van den Berg LE, Helbing WA. Stress imaging in patients with a Fontan circulation: A systematic review. Int J Cardiol 2023; 391:131192. [PMID: 37479147 DOI: 10.1016/j.ijcard.2023.131192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION The aims of this study were to provide an overview of the cardiac stress response in Fontan patients and of the use, safety and clinical value of stress imaging in Fontan patients. METHODS Studies evaluating cardiac function using stress imaging in Fontan patients published up until 12 December 2021 were included in this review. RESULTS From 1603 potential studies, 32 studies met the inclusion criteria. In total, stress imaging tests of 728 Fontan patients were included. Cardiac function was most often measured using physical stress (61%), all other studies used dobutamine-induced stress. Stroke volume (SV) increased in most studies (71%), mean SV at rest ranged from 27 mL/m2 to 60 mL/m2 versus 27 mL/m2 to 101 mL/m2 during stress, and increased with an average of 4%. Ejection fraction increased in almost all studies, whereas both end-systolic volume and end-diastolic volume decreased during stress. Higher heart rates were obtained with physical stress (82-180) compared to dobutamine induced stress (73-128). Compared to controls, increases in heartrate and SV were lower and end-diastolic volume decreased abnormally in 75% of reporting studies. No major adverse events were reported. Poorer cardiac stress response was related to decreased exercise capacity and higher risk for long-term (adverse) outcomes in Fontan patients. DISCUSSION Cardiac stress response in Fontan patients differs from healthy subjects, reflected by lower increases in heart rate, diminished preload and decreased cardiac output, especially during higher levels of exercise. Stress imaging is safe, however the added clinical value needs to be investigated in more detail.
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Affiliation(s)
- Charlotte N G Lanser
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Wessel H A van Poecke
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Linda E Scheffers
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Linda E van den Berg
- Department of Orthopedics and Sports Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands; Department of Radiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands.
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Crossley JL, Smith B, Tull M, Elsey RM, Wang T, Crossley DA. Hypoxic incubation at 50% of atmospheric levels shifts the cardiovascular response to acute hypoxia in American alligators, Alligator mississippiensis. J Comp Physiol B 2023; 193:545-556. [PMID: 37615772 DOI: 10.1007/s00360-023-01510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
We designed a series of studies to investigate whether hypoxia (10% O2) from 20% of incubation to hatching, or from 20 to 50% of incubation, affects cardiovascular function when juvenile American alligators reached an age of 4-5 years compared to juveniles that were incubated in 21% O2. At this age, we measured blood flows in all the major arteries as well as heart rate, blood pressure, and blood gases in animals in normoxia and acute hypoxia (10% O2 and 5% O2). In all three groups, exposure to acute hypoxia of 10% O2 caused a decrease in blood O2 concentration and an increase in heart rate in 4-5-year-old animals, with limited effects on blood flow in the major outflow vessels of the heart. In response to more acute hypoxia (5% O2), where blood O2 concentration decreased even further, we measured increased heart rate and blood flow in the right aorta, subclavian artery, carotid artery, and pulmonary artery; however, blood flow in the left aorta either decreased or did not change. Embryonic exposure to hypoxia increased the threshold for eliciting an increase in heart rate indicative of a decrease in sensitivity. Alligators that had been incubated in hypoxia also had higher arterial PCO2 values in normoxia, suggesting a reduction in ventilation relative to metabolism.
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Affiliation(s)
- Janna L Crossley
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas Southwestern, Dallas, TX, 75390, USA
- Department of Biological Sciences, University of North Texas, 1155 Union Circle, Denton, TX, 76203, USA
| | - Brandt Smith
- Department of Biological Sciences, University of North Texas, 1155 Union Circle, Denton, TX, 76203, USA
| | - Melissa Tull
- Department of Biological Sciences, University of North Texas, 1155 Union Circle, Denton, TX, 76203, USA
| | - Ruth M Elsey
- Louisiana Department of Wildlife and Fisheries, Rockefeller Wildlife Refuge, Grand Chenier, LA, 70643, USA
| | - Tobias Wang
- Department of Biology, Zoophysiology, Aarhus University, Aarhus C, Denmark
| | - Dane A Crossley
- Department of Biological Sciences, University of North Texas, 1155 Union Circle, Denton, TX, 76203, USA.
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Vanpeteghem CM, De Hert SG, Moerman AT. Blood pressure control with phenylephrine or dobutamine: a randomized controlled trial comparing effects on cerebral and paravertebral tissue oxygen saturation measured with near-infrared spectroscopy. J Clin Monit Comput 2023; 37:1161-1169. [PMID: 37195621 DOI: 10.1007/s10877-023-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/19/2023] [Indexed: 05/18/2023]
Abstract
Preserving haemodynamics is expected to positively affect tissue oxygen saturation. We hypothesized that maintaining mean arterial blood pressure (MAP) (using phenylephrine (PE) or dobutamine (Dobu)) would equally affect regional cerebral and paravertebral tissue saturation (rScO2 and rSpvO2, respectively). Thirty-four patients were randomly assigned to receive either PE or Dobu, in order to keep MAP within 20% of the preoperative value. Their effect on haemodynamics, rScO2 and rSpvO2 at thoracic level T3-T4, T9-T10 and lumbar level L1-L2 was calculated at different doses. Drug-induced haemodynamic effects differed between groups (∆MAP: -2%±21 and - 19%±17, ∆CI: -14.6%±14.6 and 24.1%±49.9, ∆HR: -21%±21 and 0%±16 for PE and Dobu, respectively). Both groups exhibited a significant decrease in rScO2, with a more pronounced decline in the PE group (-14.1%±16.1) compared to the Dobu group (-5.9%±10.6). There were no significant changes at the paravertebral level in either group, but a slight but statistically significant difference was detected between the two groups at T3-T4 and L1-L2. Current guidelines advocate maintaining adequate systemic blood pressures to prevent spinal cord ischaemia in specific procedures. However, it is still unknown which circulatory supportive drug is more beneficial for maintaining spinal cord perfusion. Our data indicates that, when used for maintenance of blood pressure within a 20% range of preoperative values, neither phenylephrine nor dobutamine affect paravertebral tissue saturation.
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Affiliation(s)
- Caroline M Vanpeteghem
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, 9000, Belgium.
| | - Stefan G De Hert
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| | - Anneliese T Moerman
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, 9000, Belgium
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Ishiguro A, Kabe K. Effects of Catecholamines on Blood Flow in Preterm Infants: A Subanalysis of PICC-MBF Trial. Neonatology 2023; 120:673-680. [PMID: 37660690 DOI: 10.1159/000532017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/06/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION This study evaluated the correlation between skin blood flow and systemic blood flow and whether skin blood flow can determine the circulatory effects of dopamine and dobutamine on blood flow in very low birth weight (VLBW) infants. METHODS This study was a subanalysis of the PICC-MBF randomized controlled trial. The correlation between skin blood flow and echocardiographic findings was examined. Changes in skin blood flow and blood pressure before and after initiation or dose increase of dopamine and dobutamine were also evaluated. RESULTS Two hundred and thirty-four participants underwent echocardiography. Skin blood flow was significantly correlated with supra vena cava (SVC) flow (r = 0.31, p < 0.001). Receiver operator characteristic analysis revealed that skin blood flow <17 mL/min effectively detected SVC flow <41 mL/min (area under the curve = 0.83, p < 0.001). Dobutamine significantly increased skin blood flow after initiation or dose increase (p = 0.033) without increasing blood pressure. However, dopamine significantly increased both skin blood flow (p = 0.010) and blood pressure (p < 0.001). CONCLUSIONS Our findings indicated that skin blood flow could be used as a surrogate marker of systemic blood flow in VLBW infants and revealed differences in the effects of dopamine and dobutamine on circulation.
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Affiliation(s)
- Akio Ishiguro
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kazuhiko Kabe
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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Rodenas-Alesina E, Luis Scolari F, Wang VN, Brahmbhatt DH, Mihajlovic V, Fung NL, Otsuki M, Billia F, Overgaard CB, Luk A. Improved mortality and haemodynamics with milrinone in cardiogenic shock due to acute decompensated heart failure. ESC Heart Fail 2023. [PMID: 37322827 PMCID: PMC10375068 DOI: 10.1002/ehf2.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/09/2023] [Accepted: 03/30/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Studies in cardiogenic shock (CS) often have a heterogeneous population of patients, including those with acute myocardial infarction and acute decompensated heart failure (ADHF-CS). The therapeutic profile of milrinone may benefit patients with ADHF-CS. We compared the outcomes and haemodynamic trends in ADHF-CS receiving either milrinone or dobutamine. METHODS AND RESULTS Patients presenting with ADHF-CS (from 2014 to 2020) treated with a single inodilator (milrinone or dobutamine) were included in this study. Clinical characteristics, outcomes, and haemodynamic parameters were collected. The primary endpoint was 30 day mortality, with censoring at the time of transplant or left ventricular assist device implantation. A total of 573 patients were included, of which 366 (63.9%) received milrinone and 207 (36.1%) received dobutamine. Patients receiving milrinone were younger, had better kidney function, and lower lactate at admission. In addition, patients receiving milrinone received mechanical ventilation or vasopressors less frequently, whereas a pulmonary artery catheter was more frequently used. Milrinone use was associated with a lower adjusted risk of 30 day mortality (hazard ratio = 0.52, 95% confidence interval 0.35-0.77). After propensity-matching, the use of milrinone remained associated with a lower mortality (hazard ratio = 0.51, 95% confidence interval 0.27-0.96). These findings were associated with improved pulmonary artery compliance, stroke volume, and right ventricular stroke work index. CONCLUSIONS The use of milrinone compared with dobutamine in patients with ADHF-CS is associated with lower 30 day mortality and improved haemodynamics. These findings warrant further study in future randomized controlled trials.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Luis Scolari
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Vicki N Wang
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Darshan H Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Vesna Mihajlovic
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole L Fung
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Madison Otsuki
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Overgaard
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Adriana Luk
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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10
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Yan M, Shang H, Hao L, Guo X, Zheng H, Li H, Zhao Y. A preliminary study of dobutamine myocardial flow reserve on 99mTc-Sestamibi CZT-SPECT. Ann Nucl Med 2023; 37:349-359. [PMID: 36892730 DOI: 10.1007/s12149-023-01829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND With improved resolution and sensitivity, the cadmium zinc telluride (CZT) detector measures myocardial blood flow (MBF) and myocardial flow reserve (MFR) via single photon emission computed tomography (SPECT). Recently, many studies have used vasodilator stress to obtain quantitative indexes. However, dobutamine used as a pharmaceutical stress has been rarely used to quantify myocardial perfusion using CZT-SPECT. Our study retrospectively analyzed the blood flow performance of 99mTc-Sestamibi (99mTc -MIBI) CZT-SPECT comparing dobutamine to adenosine. PURPOSE The study aims to explore whether dobutamine stress can be used for the myocardial perfusion quantitative analysis via CZT-SPECT as well as compare dobutamine MBF and MFR to adenosine. METHODS It was a retrospective study. A total of 68 patients with suspected or known coronary artery disease (CAD) were consecutively enrolled in this study. Thirty-four patients underwent dobutamine stress 99mTc-MIBI CZT-SPECT. Another thirty-four patients underwent adenosine stress 99mTc-MIBI CZT-SPECT. Patient characteristics, myocardial perfusion imaging (MPI) results, gated-myocardial perfusion imaging (G-MPI) results and quantitative analysis of MBF and MFR were collected. RESULTS In dobutamine stress group, stress MBF was significantly higher than rest MBF (median [interquartile range], 1.63 [1.46-1.94] vs. 0.89 [0.73-1.06], P < 0.001). In adenosine stress group, similar results were observed (median [interquartile range], 2.01 [1.34-2.20] vs. 0.88 [0.75-1.01], P < 0.001). When comparing the dobutamine and adenosine stress group, global MFR showed significant differences (median [interquartile range], the dobutamine group: 1.88 [1.67-2.38] vs. the adenosine group: 2.19 [1.87-2.64], P = 0.037). CONCLUSION MBF and MFR can be measured using dobutamine 99mTc -MIBI CZT-SPECT. In small sample single-center study, there was a difference in MFR produced by adenosine and dobutamine within the suspected or the known CAD population.
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Affiliation(s)
- Ming Yan
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hua Shang
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China.
| | - Luping Hao
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Xiaorui Guo
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hongming Zheng
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hongmei Li
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Yuchan Zhao
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
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11
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Anderson WL, Bateman PV, Ofner S, Li X, Maatman B, Green-Hess D, Sawada SG, Feigenbaum H. Assessment of Postsystolic Shortening and Global Longitudinal Strain Improves the Sensitivity of Dobutamine Stress Echocardiography in End-Stage Liver Disease. J Am Soc Echocardiogr 2023:S0894-7317(23)00095-0. [PMID: 36828259 DOI: 10.1016/j.echo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Dobutamine stress echocardiography (DSE) remains a widely used method for detection of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) despite low sensitivity. Speckle-tracking assessment of strain may enhance the sensitivity of DSE in the general population, but the value of strain analysis in ESLD is unknown. METHODS Dobutamine stress echocardiography with two-dimensional speckle-tracking and quantitative coronary angiography were performed in 146 patients with ESLD. Thirty-six patients (25%) had CAD (≥50% diameter stenosis of a major vessel). Global longitudinal strain at rest (GLSr) and at peak stress (GLSp) and an index of postsystolic (PSSi) shortening ([maximal extent of shortening - extent of shortening in systole]/[extent of shortening in systole]) were determined. A PSSi of ≥ 0.25 was considered evidence for CAD. Receiver operating characteristic analysis was used to determine the optimal thresholds of GLSr and GLSp for CAD and to assess the diagnostic performance of visual assessment of wall motion (WMA) and strain parameters. The sensitivity and specificity of WMA, GLSr, GLSp, and PSSi were compared. RESULTS Thirty-six patients (25%) had significant CAD. The areas under the curve for WMA, GLSr, GLSp, and PSSi were 0.60, 0.72, 0.68, and 0.78, respectively. Visual assessment of wall motion had a sensitivity of 28%. The sensitivity of each of the strain parameters, GLSr (53%, P = .016), GLSp (69%, P = .004), and PSSi (78%, P < .001), exceeded the sensitivity for WMA. Visual assessment of wall motion specificity was 92%, which exceeded the specificity for each of the strain parameters (GLSr = 82%, P = .037; GLSp = 63%, P < .001; and PSSi =78%, P = .009). Of the strain parameters, PSSi had the best balance between sensitivity and specificity (both 78%). CONCLUSION Assessment of GLS and PSSi with DSE yields better sensitivity than WMA in ELSD patients. Index of postsystolic shortening had the best diagnostic performance of all parameters in this population with a low prevalence of CAD.
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Affiliation(s)
- Wesley L Anderson
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana.
| | - Pantila V Bateman
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana; Loyola University Medical Center, Division of Cardiology, Maywood, Illinois
| | - Susan Ofner
- Department of Biostatics, and Health Data Science, Indiana University, Indianapolis, Indiana
| | - Xiaochun Li
- Department of Biostatics, and Health Data Science, Indiana University, Indianapolis, Indiana
| | - Benjamin Maatman
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana; Community Physicians Network, Cardiology, Indianapolis, Indiana
| | - Deborah Green-Hess
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana
| | - Stephen G Sawada
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana
| | - Harvey Feigenbaum
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana
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12
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Billig S, Hein M, Mechelinck M, Schumacher D, Roehl AB, Fuchs D, Kramann R, Uhlig M. Comparative assessment of coronary physiology using transthoracic pulsed-wave Doppler and myocardial contrast echocardiography in rats. Eur Radiol Exp 2023; 7:6. [PMID: 36757486 PMCID: PMC9911582 DOI: 10.1186/s41747-022-00319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/28/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Coronary physiology assessment in rodents by ultrasound is an excellent noninvasive and easy to perform technique, including pulsed-wave Doppler (PWD) and myocardial contrast echocardiography (MCE). Both techniques and the corresponding calculated parameters were investigated in this study at rest as well as their response to pharmacologically induced stress. METHODS Left ventricular myocardial function was assessed in eight anaesthetised rats using transthoracic echocardiography. Coronary physiology was assessed by both PWD of the left coronary artery and MCE using a bolus method. Measurements were performed at rest and under stimulation with adenosine and dobutamine. Effects of stimulation on the calculated parameters were evaluated and rated by effect size (η2). RESULTS Changes could be demonstrated by selected parameters of PWD and MCE. The clearest effect in PWD was found for diastolic peak velocity (η2 = 0.58). It increased from 528 ± 110 mm/s (mean ± standard deviation) at rest to 839 ± 342 mm/s (p = 0.001) with adenosine and 1093 ± 302 mm/s with dobutamine (p = 0.001). The most distinct effect from MCE was found for the normalised wash-in rate (η2 = 0.58). It increased from 1.95 ± 0.35% at rest to 3.87 ± 0.85% with adenosine (p = 0.001) and 3.72 ± 1.03% with dobutamine (p = 0.001). CONCLUSION Induced changes in coronary physiology by adenosine and dobutamine could successfully be monitored using MCE and PWD in anaesthetised rats. Due to the low invasiveness of the measurements, this protocol could be used for longitudinal animal studies.
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Affiliation(s)
- Sebastian Billig
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Marc Hein
- grid.1957.a0000 0001 0728 696XDepartment of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Mare Mechelinck
- grid.1957.a0000 0001 0728 696XDepartment of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - David Schumacher
- grid.1957.a0000 0001 0728 696XDepartment of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany ,grid.1957.a0000 0001 0728 696XInstitute of Experimental Medicine and Systems Biology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Anna B. Roehl
- grid.1957.a0000 0001 0728 696XDepartment of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Dieter Fuchs
- grid.509684.60000 0001 2309 6090FUJIFILM VisualSonics, Inc., Joop Geesinkweg 140, 1114 AB Amsterdam, The Netherlands
| | - Rafael Kramann
- grid.1957.a0000 0001 0728 696XInstitute of Experimental Medicine and Systems Biology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany ,grid.1957.a0000 0001 0728 696XDivision of Nephrology and Clinical Immunology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany ,Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Moritz Uhlig
- grid.1957.a0000 0001 0728 696XDepartment of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
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13
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Guinot PG, Durand B, Besnier E, Mertes PM, Bernard C, Nguyen M, Berthoud V, Abou-Arab O, Bouhemad B, Martin A, Duclos V, Spitz A, Constandache T, Grosjean S, Radhouani M, Anciaux JB, Missaoui A, Morgant MC, Bouchot O, Jazayeri S, Demailly Z, Huette P, Guilbart M, Besserve P, Beyls C, Dupont H, Kindo M, Wpiff T. Epidemiology, risk factors and outcomes of norepinephrine use in cardiac surgery with cardiopulmonary bypass: a multicentric prospective study. Anaesth Crit Care Pain Med 2023; 42:101200. [PMID: 36758855 DOI: 10.1016/j.accpm.2023.101200] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The present study was designed to describe the prevalence of norepinephrine use, the factors associated with its use, and the incidence of postoperative complications according to norepinephrine use, in patients undergoing cardiac surgery with cardiopulmonary bypass. METHOD We performed a prospective, multicenter, observational study in 4 University-affiliated medico-surgical cardiovascular units. We analyzed all patients treated with cardiac surgery after excluding pre-ECMO surgery, LVAD implantation, heart transplantation and intra-operative hemorrhage. RESULTS Of 9316 patients screened during the study period, 2862 were included and 2510 were analyzed. Among them, 1549 (61%) were treated with norepinephrine with a median maximal dose of 0.11 [0.06-0.2] μg.kg-1.min-1 and a median duration of 10 h [2-24]. Norepinephrine was most often started in the operating room before cardiopulmonary bypass. The multiple regression logistic analysis identified several modifiable (haematocrit, maintenance of beta-blocker, cardiopulmonary bypass time, glucose-insulin-potassium, Custodiol cardioplegia, Delnido cardioplegia, and fibrinogen transfusion) and non-modifiable factors (age, ASA score, chronic high blood pressure, coronary disease, dyslipidemia, right ventricular dysfunction, left ventricular dysfunction, active endocarditis, and valvular aortic surgery) associated with norepinephrine use. Mortality, morbidity (neurological and renal complications, death) and length of stay in the ICU were higher in patients treated with norepinephrine. CONCLUSION Norepinephrine is often used in cardiac surgical patients but for <24 h with a low dose. Many preoperative and surgical factors are associated with norepinephrine use. Patients supported by norepinephrine have a higher incidence of major postoperative events.
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Affiliation(s)
- Pierre-Grégoire Guinot
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France.
| | - Bastien Durand
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care Medicine, Rouen University Medical Centre, 76000 Rouen, France
| | - Paul-Michel Mertes
- Department of Anaesthesiology and Critical Care Medicine, Strasbourg University Medical Centre, Strasbourg, France
| | - Chloe Bernard
- Department of Cardiac Surgery, Dijon University Medical Centre, 21000 Dijon, France
| | - Maxime Nguyen
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France
| | - Vivien Berthoud
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Osama Abou-Arab
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Medical Centre, 80000 Amiens, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France
| | - Audrey Martin
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Valerian Duclos
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Alexandra Spitz
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Tiberiu Constandache
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Sandrine Grosjean
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Mohamed Radhouani
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Jean-Baptiste Anciaux
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Anis Missaoui
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Marie-Catherine Morgant
- Department of Anaesthesiology and Critical Care Medicine, Rouen University Medical Centre, 76000 Rouen, France
| | - Olivier Bouchot
- Department of Anaesthesiology and Critical Care Medicine, Rouen University Medical Centre, 76000 Rouen, France
| | - Saed Jazayeri
- Department of Anaesthesiology and Critical Care Medicine, Rouen University Medical Centre, 76000 Rouen, France
| | - Zoe Demailly
- Department of Anaesthesiology and Critical Care Medicine, Rouen University Medical Centre, 76000 Rouen, France
| | - Pierre Huette
- Department of Anaesthesiology and Critical Care Medicine, Strasbourg University Medical Centre, Strasbourg, France
| | - Mathieu Guilbart
- Department of Anaesthesiology and Critical Care Medicine, Strasbourg University Medical Centre, Strasbourg, France
| | - Patricia Besserve
- Department of Anaesthesiology and Critical Care Medicine, Strasbourg University Medical Centre, Strasbourg, France
| | - Christophe Beyls
- Department of Anaesthesiology and Critical Care Medicine, Strasbourg University Medical Centre, Strasbourg, France
| | - Hervé Dupont
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Thibaut Wpiff
- Department of Cardiac Surgery, Dijon University Medical Centre, 21000 Dijon, France
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14
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Salatzki J, Ochs A, Kirchgäßner N, Heins J, Seitz S, Hund H, Mereles D, Friedrich MG, Katus HA, Frey N, André F, Ochs MM. Safety of Stress Cardiac Magnetic Resonance in Patients With Moderate to Severe Aortic Valve Stenosis. J Cardiovasc Imaging 2023; 31:26-38. [PMID: 36693342 PMCID: PMC9880345 DOI: 10.4250/jcvi.2022.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dobutamine and adenosine stress cardiac magnetic resonance (CMR) imaging is relatively contraindicated in patients with moderate to severe aortic valve stenosis (AS). We aimed to determine the safety of dobutamine and adenosine stress CMR in patients with moderate to severe AS. METHODS In this retrospective study patients with AS who underwent either dobutamine or adenosine stress CMR for exclusion of obstructive coronary artery disease were enrolled. We recorded clinical data, CMR and echocardiography findings, and complications as well as minor symptoms. Patients with AS were compared to matched individuals without AS. RESULTS A total of 187 patients with AS were identified and compared to age-, gender- and body mass index-matched 187 patients without AS. No severe complications were reported in the study nor the control group. The reported frequency of non-severe complications and minor symptoms were similar between the study and the control groups. Nineteen patients with AS experienced non-severe complications or minor symptoms during dobutamine stress CMR compared to eighteen patients without AS (p = 0.855). One patient with AS and two patients without AS undergoing adenosine stress CMR experienced minor symptoms (p = 0.562). Four examinations were aborted because of chest pain, paroxysmal atrial fibrillation and third-degree atrioventricular block. Inducible ischaemia, prior coronary artery bypass grafting, prior stroke and age were associated with a higher incidence of complications and minor symptoms. CONCLUSIONS Moderate to severe AS was not associated with complications during CMR stress test. The incidence of non-severe complications and minor symptoms was greater with dobutamine.
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Affiliation(s)
- Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Andreas Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Nadja Kirchgäßner
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jannick Heins
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Seitz
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hauke Hund
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
| | - Derliz Mereles
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Matthias G. Friedrich
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Cardiology, Departments of Medicine and Diagnostic Radiology, Mc-Gill University Health Centre, Montreal, Canada
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco M. Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
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15
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Noel E, Fayoda B, Rabbani R, Benjamin YS, Lee J, Gillespie A. Dobutamine-Induced Myoclonus in a Peritoneal Dialysis Patient: Case Report. Kidney Med 2022; 5:100591. [PMID: 36686274 PMCID: PMC9851887 DOI: 10.1016/j.xkme.2022.100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Dobutamine is a weak beta-1 and a potent beta-2 adrenergic agonist commonly used to treat patients in cardiogenic shock. It enhances myocardial contractibility, increasing cardiac output. Myoclonus in patients receiving an infusion of dobutamine is rare and, although not fully understood, seems more common in patients with severe kidney failure. To our knowledge, this is the first reported case of dobutamine-induced myoclonus in a patient with kidney failure receiving peritoneal dialysis. Only 7% of the 518,749 patients of the United States requiring kidney replacement therapy receive peritoneal dialysis, with only a small unknown number of those with advanced heart failure manage with an infusion of inotropic medication. The low prevalence of combined advanced heart failure and kidney failure could partly explain this condition's rarity. In this study, we report the case of a 64-year-old woman with kidney failure receiving peritoneal dialysis in whom myoclonus developed 3 weeks after starting a dobutamine infusion for advanced refractory heart failure. Infectious and other pharmacologic causes of myoclonus were ruled out. Initially, uremia was suspected; however, despite increasing her peritoneal dialysis dose, it was only after discontinuing the dobutamine infusion that her myoclonus resolved.
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Affiliation(s)
- Edva Noel
- Department of Nephrology, Temple University Hospital, Philadelphia, PA,Address for Correspondence: Edva Noel, MD, Department of Nephrology, Temple University Hospital, 3440 N. Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140
| | - Bolajoko Fayoda
- Department of Nephrology, Temple University Hospital, Philadelphia, PA
| | - Rizwan Rabbani
- Department of Nephrology, Temple University Hospital, Philadelphia, PA
| | - Yves-Smith Benjamin
- Department of Nephrology, Riverside University Health System, Moreno Valley, CA
| | - Jean Lee
- Department of Nephrology, Temple University Hospital, Philadelphia, PA
| | - Avrum Gillespie
- Department of Nephrology, Temple University Hospital, Philadelphia, PA
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16
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Abstract
Management of the patient with sepsis comprises three key branches: control of the underlying infection, haemodynamic stabilization, and modulation of the host response. Each aspect should be considered in all patients and, when relevant, managed at the same time. Infection control is applicable to all patients with sepsis and will include antibiotic therapy and often surgical intervention to remove an infectious source. Haemodynamic support involves fluid administration in all patients and vasoactive agents in patients with associated circulatory shock. Noradrenaline is the first choice vasopressor agent; inotropic agents, usually dobutamine, may be added in case of myocardial depression. No interventions directed at individual components of the host response to sepsis have yet been shown to improve outcomes, but glucocorticoids and vasopressin have a global impact on the response and can thus be considered in this category. A move toward more personalized treatment is needed across all three arms of sepsis management.
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Affiliation(s)
- Jean-Louis Vincent
- Corresponding author. Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, 1070 Brussels, Belgium.
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17
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Fernandes S, Oatman E, Weinberger J, Dixon A, Osei-Owusu P, Hou S. The susceptibility of cardiac arrhythmias after spinal cord crush injury in rats. Exp Neurol 2022; 357:114200. [PMID: 35952765 PMCID: PMC9801389 DOI: 10.1016/j.expneurol.2022.114200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/03/2023]
Abstract
High-level spinal cord injury (SCI) often interrupts supraspinal regulation of sympathetic input to the heart. Although it is known that dysregulated autonomic control increases the risk for cardiac disorders, the mechanisms mediating SCI-induced arrhythmias are poorly understood. Here, we employed a rat model of complete spinal cord crush injury at the 2nd/3rd thoracic (T2/3) level to investigate cardiac rhythm disorders resulting from SCI. Rats with T9 injury and naïve animals served as two controls. Four weeks after SCI, rats were implanted with a radio-telemetric device for electrocardiogram and blood pressure monitoring. During 24-h recordings, heart rate variability in rats with T2/3 but not T9 injury exhibited a significant reduction in the time domain, and a decrease in power at low frequency but increased power at high frequency in the frequency domain which indicates reduced sympathetic and increased parasympathetic outflow to the heart. Pharmacological blockade of the sympathetic or parasympathetic branches confirmed the imbalance of cardiac autonomic control. Activation of sympatho-vagal input during the induction of autonomic dysreflexia by colorectal distention triggered various severe arrhythmic events in T2/3 injured rats. Meanwhile, intravenous infusion of the β1-adrenergic receptor agonist, dobutamine, caused greater incidence of arrhythmias in rats with T2/3 injury than naïve and T9 injured controls. Together, the results indicate that high-level SCI increases the susceptibility to developing cardiac arrhythmias likely owing to compromised autonomic homeostasis. The T2/3 crush model is appropriate for studying abnormal cardiac electrophysiology resulting from SCI.
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Affiliation(s)
- Silvia Fernandes
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Emily Oatman
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Jeremy Weinberger
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Alethia Dixon
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Patrick Osei-Owusu
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Shaoping Hou
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA.
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18
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Abstract
Purpose of Review
Stress echocardiography is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms during activities of daily living. We describe the current methodology and the evidence supporting these applications. Recent Findings The comprehensive stress echo assessment includes valve function (gradients and regurgitation), left ventricular global systolic and diastolic function, left atrial volume, pulmonary congestion, pulmonary arterial pressure, and right ventricular function, integrated with blood pressure response with cuff sphygmomanometer, chronotropic reserve with heart rate, and symptoms. Summary Recent guidelines recommend the evaluation of asymptomatic severe or symptomatic non-severe mitral regurgitation or stenosis with exercise stress and suspected low-flow, low-gradient severe aortic stenosis with reduced ejection fraction with low dose (up to 20 mcg, without atropine) dobutamine stress. Prospective, large-scale studies based on a comprehensive protocol (ABCDE +) capturing the multiplicity of clinical phenotypes are needed to support stress echo-driven treatment strategies.
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Affiliation(s)
- Rodolfo Citro
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni Di Dio E Ruggi d, Aragona University Hospital, Salerno, Italy
- Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Francesca Bursi
- Dipartimento Di Scienze Della Salute, ASST Santi Paolo E Carlo Milano, Università Degli Studi Statale Di Milano, Ospedale San Paolo, Milan, Italy
| | - Michele Bellino
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, CNR Research Campus, Via Moruzzi, 1, Building C, First floor, Room 130, 56124, Pisa, Italy.
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Wu YF, Pan Y, Tang Q, Lou N, Wang DF. Early administration of dobutamine in the treatment of septic shock patients with tumor-a retrospective comparative cohort study. Ann Transl Med 2022; 10:828. [PMID: 36035000 PMCID: PMC9403911 DOI: 10.21037/atm-22-3226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
Background Studies have found that dobutamine may be beneficial to protect organs function in patients with septic shock, but there is still a lack of relevant research in septic shock patients with tumor. The study sought to explore the role of the early administration of dobutamine in the treatment of septic shock patients with tumors. Methods We retrospectively collected the data of tumor patients who developed septic shock at Sun Yat-sen University Cancer Center between June 2008 and November 2021. All the patients were divided into the following 3 groups: (I) the early administration group (<3 days, n=15); (II) the late administration group (≥3 days, n=22); and (III) the non-administration group (n=85). The primary observation indicator was 28-day mortality, and the secondary observation indicators included the shock reversal rate, the length of stay in the intensive care unit (ICU) and the duration of mechanical ventilation. There was no statistical difference in the basic data of the three groups. Results The early administration group had a significant decrease in 28-day mortality compared to the late and non-administration groups (log-rank P=0.018). The comparison between the groups showed that the 28-day mortality of the early administration group was significantly lower than that of the non-administration group [20.0% vs. 58.8%, P=0.013, hazard ratios (HRs) =0.248, 95% confidence intervals (CIs): 0.077-0.796]. There was no statistically significant difference in 28-day mortality between the late administration group and the non-administration group (63.6% vs. 58.8%, P=0.682, HR =0.983, 95% CI: 0.543-1.778). Additionally, the early administration group had a significantly increased shock reversal rate (P=0.014), shortened length of stay in the ICU (P<0.001), and reduced duration of mechanical ventilation (P=0.049). Conclusions Early use of dobutamine may be beneficial to reduce the in-hospital mortality of septic shock patients with tumor, but the sample size of this study was small, which still needs to be confirmed by a multi-center randomized controlled clinical study.
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Affiliation(s)
- Ya-Fei Wu
- Department of Critical Care Medicine, Sun Yat-sen University Cancer Center (State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine), Guangzhou, China
| | - Yin Pan
- Department of Critical Care Medicine, Sun Yat-sen University Cancer Center (State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine), Guangzhou, China
| | - Qiang Tang
- Department of Critical Care Medicine, Sun Yat-sen University Cancer Center (State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine), Guangzhou, China
| | - Ning Lou
- Department of Critical Care Medicine, Sun Yat-sen University Cancer Center (State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine), Guangzhou, China
| | - Dao-Feng Wang
- Department of Critical Care Medicine, Sun Yat-sen University Cancer Center (State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine), Guangzhou, China
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20
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Prosperi-Porta G, Motazedian P, Di Santo P, Jung RG, Parlow S, Abdel-Razek O, Simard T, Hutson J, Malhotra N, Fu A, Ramirez FD, Froeschl M, Mathew R, Hibbert B. No sex-based difference in cardiogenic shock: A post-hoc analysis of the DOREMI trial. J Cardiol 2022; 80:358-364. [PMID: 35725945 DOI: 10.1016/j.jjcc.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) is associated with significant morbidity and mortality; however, there are limited randomized data evaluating the association between sex and clinical outcomes in patients with CS. Patients with CS enrolled in the DObutamine compaREd with MIlrinone (DOREMI) trial were evaluated in this post-hoc analysis. METHODS The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary outcome. We analyzed the primary and secondary outcomes using unadjusted relative risks and performed adjusted analysis for the primary outcome and all-cause mortality using the covariates mean arterial pressure <70 mmHg at inotrope initiation, age, and acute myocardial infarction CS. RESULTS Among 192 participants in the DOREMI study, 70 patients (36 %) were female. The primary outcome occurred in 38 female patients (54 %) compared to 61 male patients (50 %) [adjusted relative risk (aRR) 1.23; 95 % CI 0.78-1.95, p = 0.97]. When stratified by inotrope, there was no difference in the primary outcome comparing females to males receiving dobutamine (RR 1.14; 95 % CI 0.79-1.65, p = 0.50) nor milrinone (RR 1.03; 95 % CI 0.68-1.57, p = 0.87). There was no difference in all-cause mortality comparing females to males (aRR 1.51; 95 % CI 0.78-2.94, p = 0.88). Additionally, there were no differences in any secondary outcomes between males and females (p > 0.05 for all endpoints). CONCLUSION In patients presenting with CS treated with milrinone or dobutamine, no differences in clinical outcomes were observed between males and females.
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Affiliation(s)
- Graeme Prosperi-Porta
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Jordan Hutson
- Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Nikita Malhotra
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Angel Fu
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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21
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Abadie B, Jaber W. Dobutamine stress PET/CT for assessment of hemodynamic significance of coronary myocardial bridges. J Nucl Cardiol 2022; 29:1447-1451. [PMID: 34355308 DOI: 10.1007/s12350-021-02759-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Myocardial bridges are common and often benign, but can cause hemodynamically significant obstruction of blood flow with stress. Dobutamine stress positron emission tomography/computed tomography (PET/CT) is a powerful tool for non-invasively assessing for ischemia. We present a case of using dobutamine stress PET/CT to determine the significance of a myocardial bridge.
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22
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McPherson A, Nguyen C, Groninger H, Anderson KM, Henderson P, Rao A. Continuous Intravenous Inotropic Support for Advanced Heart Failure: Palliative Considerations. J Pain Palliat Care Pharmacother 2022; 36:59-67. [PMID: 35319327 DOI: 10.1080/15360288.2022.2050456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The global prevalence of heart failure (HF) is increasing. Advancements in guideline-directed medical and device therapy have resulted in improved survival. Thus, there are more patients living - and living longer - with advanced HF. Only a small proportion of these patients are deemed appropriate for advanced surgical intervention (mechanical circulatory support or heart transplantation), and even if offered, some may decline such interventions if not aligned with their overall goals and values. Therefore, a growing number of patients with advanced HF receive chronic intravenous inotropic support (CIIS) for palliation of symptoms. Despite increased use, clinical evidence supporting use of palliative inotropes remains limited. However, available data suggest improvements in functional class, health-related quality of life (HRQoL) indicators, symptom burden, hemodynamic parameters, and possibly rehospitalization. While initial concerns regarding increased mortality have been assuaged in the modern era of guideline-directed medical therapy, palliative inotropes are certainly not without burden. Risks of infection and medication-related adverse effects, need for routine laboratory monitoring, frequent dressing changes, and presence of a reliable caregiver must be carefully considered prior to initiation. This review addresses pharmacology, guideline recommendations, benefits and burdens, considerations related to hospice and end-of-life care, and future directions of CIIS in advanced HF care.
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23
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Xia R, He B, Zhu T, Zhang Y, Chen Y, Wang L, Zhou Y, Liao J, Zheng J, Li Y, Lv F, Gao F. Low-dose dobutamine cardiovascular magnetic resonance segmental strain study of early phase of intramyocardial hemorrhage rats. BMC Med Imaging 2021; 21:173. [PMID: 34800982 PMCID: PMC8605595 DOI: 10.1186/s12880-021-00709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background This study investigates the segmental myocardial strain of the early phase of intramyocardial hemorrhage (IMH) caused by reperfused myocardial infarction (MI) in rats by low-dose dobutamine (LDD) cardiovascular magnetic resonance (CMR) feature-tracking. Methods Nine sham rats and nine rats with 60-min myocardial ischemia followed by 48-h reperfusion were investigated using CMR, including T2*-mapping sequence and fast imaging with steady-state precession (FISP)–cine sequence. Another FISP–cine sequence was acquired after 2 min of dobutamine injection; the MI, IMH, and Non-MI (NMI) areas were identified. The values of peak radial strains (PRS) and peak circumferential strains (PCS) of the MI, IMH and NMI segments were acquired. The efficiency of PRS and PCS (EPRS and EPCS, respectively) were calculated on the basis of the time of every single heartbeat. Results The PRS, PCS, EPRS, and EPCS of the sham group increased after LDD injection. However, the PRS, PCS, EPRS, and EPCS of the IMH segment did not increase. Moreover, the PRS and PCS of the MI and NMI segments did not increase, but the EPRS and EPCS of these segments increased. The PRS, PCS, EPRS, and EPCS of the IMH segment were lower than those of the MI and NMI segments before and after LDD injection, but without a significant difference between MI segment and NMI segment before and after LDD injection. Conclusions LDD could help assess dysfunctions in segments with IMH, especially using the efficiency of strain. IMH was a crucial factor that decreased segmental movement and reserved function.
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Affiliation(s)
- Rui Xia
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Bo He
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Tong Zhu
- Department of Radiology, TongJi Hospital, TongJi Medical College, HuaZhong University of Science & Technology, Hankou, 430030, Wuhan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yushu Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lei Wang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yang Zhou
- Department of Pathology, Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Jichun Liao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Saint Louis, MO, 63110, USA
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Fabao Gao
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China.
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Abstract
BACKGROUND The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients. METHODS Based on the analysis of MIMIC III public database, we performed a big-data, real world study. According to the use of dobutamine or not, patients were categorized as the dobutamine group or non dobutamine group.We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. RESULTS In the present study, after screening 38,605 patients, 2826 patients with sepsis were included. 121 patients were in dobutamine group and 2165 patients were in non dobutamine group. Compared with patients in non-dobutamine group, patients in dobutamine group had a lower MAP, higher HR, higher RR, higher severity of illness scores. 72 of 121 patients (59.5%) in the dobutamine group and 754 of 2165 patients (34.8%) in the non-dobutamine group died in the hospital, which resulted in a significant between-group difference (OR 1.56, 95% CI 1.01-2.40; P = 0.000). For the secondary outcomes, patients in dobutamine group received more MV use, more renal replacement therapy use, had longer ICU stay durations and more cardiac arrhythmias than those in non-dobutamine group. After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistently higher in dobutamine group than that in non-dobutamine group (60.2% vs. 49.4%, OR 1.55, 95% CI 1.01-2.37; P = 0.044). CONCLUSIONS Among patients with sepsis, our study showed that the use of dobutamine was not associated with decreased hospital mortality. Further large scale, randomized controlled studies are warrented to confirm our findings.
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Affiliation(s)
- Youfeng Zhu
- grid.258164.c0000 0004 1790 3548Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangdong 510220 Guangzhou, China
| | - Haiyan Yin
- grid.412601.00000 0004 1760 3828Department of Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, 510220 Guangdong China
| | - Rui Zhang
- grid.258164.c0000 0004 1790 3548Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangdong 510220 Guangzhou, China
| | - Xiaoling Ye
- grid.258164.c0000 0004 1790 3548Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangdong 510220 Guangzhou, China
| | - Jianrui Wei
- grid.413428.80000 0004 1757 8466Guangzhou Women and Children’s Medical Center, No. 9 Jinsui Road, Guangzhou, 510220 Guangdong China
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25
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Parlow S, Di Santo P, Mathew R, Jung RG, Simard T, Gillmore T, Mao B, Abdel-Razek O, Ramirez FD, Marbach JA, Dick A, Glover C, Russo JJ, Froeschl M, Labinaz M, Fernando SM, Hibbert B. The association between mean arterial pressure and outcomes in patients with cardiogenic shock: insights from the DOREMI trial. Eur Heart J Acute Cardiovasc Care 2021; 10:712-720. [PMID: 34382063 DOI: 10.1093/ehjacc/zuab052] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/18/2021] [Accepted: 06/26/2021] [Indexed: 11/14/2022]
Abstract
AIMS Cardiogenic shock (CS) is a state of low cardiac output resulting in end-organ hypoperfusion. Despite high in-hospital mortality rates, little evidence exists regarding the optimal mean arterial pressure (MAP) target in CS. We therefore evaluated the relationship between achieved MAP and clinical outcomes in patients with CS. METHODS AND RESULTS We performed a post hoc analysis of the CAPITAL DOREMI trial: a randomized, double-blind trial comparing dobutamine to milrinone in patients with CS. We divided patients into a high MAP group (average MAP ≥ 70 mmHg over the 36 h following randomization), and a low MAP group (average MAP < 70 mmHg). Our primary outcome included in-hospital all-cause mortality, resuscitated cardiac arrest, need for cardiac transplantation or mechanical circulatory support, non-fatal myocardial infarction, transient ischaemic attack or stroke, or initiation of renal replacement therapy. In total, 71 (37.0%) patients achieved an average MAP < 70 mmHg, and 121 (63.0%) achieved an average MAP ≥ 70 mmHg. The primary outcome occurred in 48 (67.6%) patients in the low MAP group and 51 (42.2%) patients in the high MAP group [adjusted relative risk (aRR) 0.70; 95% confidence interval (CI) 0.53-0.92; P = 0.01]. All-cause mortality occurred in 41 (57.8%) and 35 (28.9%) patients in the low and high MAP groups, respectively (aRR 0.56; 95% CI 0.40-0.79; P < 0.01). There were no significant differences in any secondary outcomes between each group. CONCLUSIONS In patients with CS treated with inotrope therapy, low MAP is associated with worse clinical outcomes. Randomized data evaluating optimal MAP targets in CS is needed to guide medical therapy.
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Affiliation(s)
- Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario, K1G 5Z3, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, K1H 8M5, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room #3206, Ottawa, Ontario, K1H 8M5, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room #3206, Ottawa, Ontario, K1H 8M5, Canada.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, 200 First St. SW, Rochester, Minnesota, 55905, USA
| | - Taylor Gillmore
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, K1H 8M5, Canada
| | - Brennan Mao
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, K1H 8M5, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111, USA
| | - Alexander Dick
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Christopher Glover
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Juan J Russo
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Shannon M Fernando
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Critical Care, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room #3206, Ottawa, Ontario, K1H 8M5, Canada
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26
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Di Santo P, Mathew R, Jung RG, Simard T, Skanes S, Mao B, Ramirez FD, Marbach JA, Abdel-Razek O, Motazedian P, Parlow S, Boczar KE, D'Egidio G, Hawken S, Bernick J, Wells GA, Dick A, So DY, Glover C, Russo JJ, McGuinty C, Hibbert B. Impact of baseline beta-blocker use on inotrope response and clinical outcomes in cardiogenic shock: a subgroup analysis of the DOREMI trial. Crit Care 2021; 25:289. [PMID: 34376218 PMCID: PMC8356445 DOI: 10.1186/s13054-021-03706-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/19/2021] [Indexed: 12/29/2022]
Abstract
Background Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS. Methods Patients with CS enrolled in the DObutamine compaREd to MIlrinone trial were analyzed. The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, need for cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite and hemodynamic response profiles derived from pulmonary artery catheters. Results Among 192 participants, 93 patients (48%) had received BB therapy. The primary outcome occurred in 47 patients (51%) in the BB group and in 52 (53%) in the no BB group (RR 0.96; 95% CI 0.73–1.27; P = 0.78) throughout the in-hospital period. There were fewer early deaths in the BB group (RR 0.41; 95% CI 0.18–0.95; P = 0.03). There were no differences in other individual components of the primary outcome or in hemodynamic response between the two groups throughout the remainder of the hospitalization. Conclusions BB therapy in the 24 h preceding the development of CS did not negatively influence clinical outcomes or hemodynamic parameters. On the contrary, BB use was associated with fewer deaths in the early resuscitation period, suggesting a paradoxically protective effect in patients with CS. Trial registration ClinicalTrials.gov Identifier: NCT03207165
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Brennan Mao
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France.,LIRYC (L'Institut de Rythmologie Et Modélisation Cardiaque), Bordeaux-Pessac, France
| | - Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Division of Critical Care, Tufts Medical Center, Boston, MA, USA
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Department of Medicine, Cumming School of Medicine, Calgary, AB, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin E Boczar
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gianni D'Egidio
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Steven Hawken
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alexander Dick
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Derek Y So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Glover
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Juan J Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Caroline McGuinty
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada. .,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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Abstract
Background Bidirectional ventricular tachycardia (BD-VT) is an intriguing arrhythmia, characterized by a beat-to-beat alternation of the QRS polarity on electrocardiogram. Currently there is no simple BD-VT animal model. Objective We report a simple animal model of BD-VT induced by caffeine and dobutamine (C+D) challenge in normal rats in which the arrhythmia can be attenuated by dantrolene (a ryanodine receptor stabilizer) treatment, but not by the pacemaker channel blocker ivabradine treatment. Methods Adult (4–5 months old) Sprague-Dawley rats (both sexes) were randomized into C+D (n = 8, received caffeine 120 mg/kg intraperitoneally [IP] and dobutamine 60 μg/kg IP, sequentially) and control (n = 8) groups. In addition, a group of 7 rats were pretreated with dantrolene (10 mg/kg, IP) 30 minutes before the C+D challenge and another group of 8 rats were pretreated with ivabradine (5 mg/kg, IP) 30 minutes before the C+D challenge. Results C+D challenge induced spontaneous premature ventricular contractions (PVCs) in 7 of 8 rats and BD-VT (lasted 4.3 ± 2.9 minutes, terminated spontaneously) in 6 of 8 (75%) rats. No ventricular arrhythmia was induced in the control group (P < .05 vs C+D group). Dantrolene treatment significantly decreased BD-VT (1 of 7 rats in the Dantrolene+C+D group vs 6 of 8 rats in C+D group, P < .05). Ivabradine treatment did not affect C+D-induced BD-VT (7 of 8 rats in the Ivabradine+C+D group vs 6 of 8 in the C+D group, P > .05). Conclusion Caffeine and dobutamine challenge induces BD-VT in a majority of normal rats. Stabilizing cardiac ryanodine receptors with dantrolene treatment can significantly decrease the occurrence of BD-VT, but pacemaker channel blocker ivabradine treatment does not have effect in this animal model.
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Affiliation(s)
- Chenyu Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
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Hyldebrandt JA, Bøgh N, Omann C, Agger P. Norepinephrine and dobutamine improve cardiac index equally by supporting opposite sides of the heart in an experimental model of chronic pulmonary hypertension. Intensive Care Med Exp 2021; 9:29. [PMID: 34085137 PMCID: PMC8175098 DOI: 10.1186/s40635-021-00391-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary hypertension is a significant risk factor in patients undergoing surgery. The combined effects of general anaesthesia and positive pressure ventilation can aggravate this condition and cause increased pulmonary blood pressures, reduced systemic blood pressures and ventricular contractility. Although perioperative use of inotropic support or vasopressors is almost mandatory for these patients, preference is disputed. In this study, we investigated the effects of norepinephrine and dobutamine and their ability to improve the arterio-ventricular relationship and haemodynamics in pigs suffering from chronic pulmonary hypertension. METHOD Pulmonary hypertension was induced in five pigs by banding the pulmonary artery at 2-3 weeks of age. Six pigs served as controls. After 16 weeks of pulmonary artery banding, the animals were re-examined under general anaesthesia using biventricular conductance catheters and a pulmonary artery catheter. After baseline measurements, the animals were exposed to both norepinephrine and dobutamine infusions in incremental doses, with a stabilising period in between the infusions. The hypothesis of differences between norepinephrine and dobutamine with incremental doses was tested using repeated two-way ANOVA and Bonferroni multiple comparisons post-test. RESULTS At baseline, pulmonary artery-banded animals had increased right ventricular pressure (+ 39%, p = 0.04), lower cardiac index (- 23% p = 0.04), lower systolic blood pressure (- 13%, p = 0.02) and reduced left ventricular end-diastolic volume (- 33%, p = 0.02). When incremental doses of norepinephrine and dobutamine were administered, the right ventricular arterio-ventricular coupling was improved only by dobutamine (p < 0.05). Norepinephrine increased both left ventricular end-diastolic volume and left ventricular contractility to a greater extent (p < 0.05) in pulmonary artery-banded animals. While the cardiac index was improved equally by norepinephrine and dobutamine treatments in pulmonary artery-banded animals, norepinephrine had a significantly greater effect on mean arterial pressure (p < 0.05) and diastolic arterial pressure (p < 0.05). CONCLUSION While norepinephrine and dobutamine improved cardiac index equally, it was obtained in different manners. Dobutamine significantly improved the right ventricular function and the arterio-ventricular coupling. Norepinephrine increased systemic resistance, thereby improving arterial pressures and left ventricular systolic function by maintaining left ventricular end-diastolic volume.
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Affiliation(s)
- Janus Adler Hyldebrandt
- Department of Anesthesia and Intensive Care, Akershus University Hospital, Postbox 1000, 1478, Lørenskog, Norway.
| | - Nikolaj Bøgh
- MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Camilla Omann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Agger
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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29
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Ozaki K, Okubo T, Hagiya K, Kubota N, Tsuchida K, Takahashi K, Oda H, Minamino T. Unstable angina complicated with dynamic left ventricular outflow tract obstruction. J Cardiol Cases 2021; 23:181-188. [PMID: 33841598 DOI: 10.1016/j.jccase.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
Left ventricular outflow tract obstruction (LVOTO) complicated with unstable angina (uAP) has not been described widely, but patients with these two conditions have several problems. Differentiation of the two conditions is also often difficult because the chest symptoms are similar. Moreover, nitrates are commonly used for ischemic heart disease, but have the effect of worsening LVOTO. We experienced three cases of dynamic LVOTO with a sigmoid-shaped septum, and without typical hypertrophic obstructive cardiomyopathy, that were complicated with uAP. In all cases, LVOTO was improved after initial percutaneous coronary intervention (PCI) for the left anterior descending artery lesion. Next, a dobutamine stress test was performed and LVOTO was provoked again in two cases, but not in a case with small acute myocardial infarction of the basal septum during PCI. All cases remained asymptomatic with beta-blocker therapy. Therefore, PCI and beta-blocker administration for LVOTO with uAP resulted in favorable clinical courses in all three cases. These outcomes suggest that revascularization including PCI should have priority in the therapeutic strategy for a case of acute coronary syndrome with LVOTO.
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Affiliation(s)
- Kazuyuki Ozaki
- Department of Cardiology, Niigata City General Hospital, Japan.,Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
| | - Takeshi Okubo
- Department of Cardiology, Niigata City General Hospital, Japan.,Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Niigata City General Hospital, Japan.,Department of Cardiology, Sakakibara Heart Institute, Japan
| | - Naoki Kubota
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
| | | | | | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
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30
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Inocencio IM, Tran NT, Khor SJ, Wiersma M, Nakamura S, Walker DW, Wong FY. The cerebral haemodynamic response to somatosensory stimulation in preterm newborn lambs is reduced with dopamine or dobutamine infusion. Exp Neurol 2021; 341:113687. [PMID: 33713656 DOI: 10.1016/j.expneurol.2021.113687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In the adult brain, increases in neural activity lead to increases in local blood flow. However, in the preterm neonate, studies of cerebral functional haemodynamics have yielded inconsistent results, including negative responses suggesting decreased perfusion and localised tissue hypoxia, probably due to immature neurovascular coupling. Furthermore, the impact of vasoactive medications, such as dopamine and dobutamine used as inotropic therapies in preterm neonates, on cerebrovascular responses to somatosensory input is unknown. We aimed to characterise the cerebral haemodynamic functional response after somatosensory stimulation in the preterm newborn brain, with and without dopamine or dobutamine treatment. METHODS We studied the cerebral haemodynamic functional response in 13 anaesthetised preterm lambs, using near infrared spectroscopy to measure changes in cerebral oxy- and deoxyhaemoglobin (ΔoxyHb, ΔdeoxyHb) following left median nerve stimulation using stimulus trains of 1.8, 4.8 and 7.8 s. The 4.8 and 7.8 s stimulations were repeated during dopamine or dobutamine infusion. RESULTS Stimulation always produced a somatosensory evoked response. Majority of preterm lambs demonstrated positive functional responses (i.e. increased ΔoxyHb) in the contralateral cortex following stimulus trains of all durations. Dopamine increased baseline oxyHb and total Hb, whereas dobutamine increased baseline deoxyHb. Both dopamine and dobutamine reduced the evoked ΔoxyHb responses to 4.8 and 7.8 s stimulations. CONCLUSIONS Somatosensory stimulation increases cerebral oxygenation in the preterm brain, consistent with increased cerebral blood flow due to neurovascular coupling. Notably, our results show that dopamine/dobutamine reduces oxygen delivery relative to consumption in the preterm brain during somatosensory stimulations, suggesting there may be a risk of intermittent localised tissue hypoxia which has clear implications for clinical practice and warrants further investigation.
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Affiliation(s)
- Ishmael M Inocencio
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | - Nhi T Tran
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; School of Health & Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Song J Khor
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | - Manon Wiersma
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | - Shinji Nakamura
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - David W Walker
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; School of Health & Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Flora Y Wong
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; Monash Newborn, Monash Medical Centre, Melbourne, Australia.
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31
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John B, Babu M, Shaji S, Abraham S, Abdullakutty J. Clinical outcomes of levosimendan versus dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function. Indian Heart J 2021; 73:372-5. [PMID: 34154760 DOI: 10.1016/j.ihj.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/26/2021] [Accepted: 02/14/2021] [Indexed: 11/23/2022] Open
Abstract
To assess the clinical outcomes of levosimendan and dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function in Indian scenario. Cardiac, renal, electrolytes and hepatic parameters as well as the clinical outcomes were assessed. Levosimendan and dobutamine improved ejection fraction significantly. Levosimendan in comparison to dobutamine, increased cardiac output (0.76 vs. −0.38 at 48 h, 1.15 vs. −0.31 day 7, -2.02 vs. −1.51 day 30), cardiac index (0.89 vs.-0.13 at 48 h, 1.16 vs. −0.07 at day 7 and 1.05 vs. −0.25 at day 30) and eGFR (−1.4 vs. −0.75 at day 30) significantly. Levosimendan reduced ICU stay (p = 0.038) significantly whereas dobutamine decreased the hospital stay duration (p = 0.015). There was no major difference in re-hospitalization and mortality between groups. Ventricular tachyarrhythmia was the main adverse event noted in Levosimendan arm. Levosimendan showed improved cardiac as well as renal outcomes within a month when compared to dobutamine and it is the first study to determine the renal parameters of Levosimendan in an Indian setting.
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Chan CC, Lee KT, Ho WJ, Chan YH, Chu PH. Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study. Ann Intensive Care 2021; 11:27. [PMID: 33555483 PMCID: PMC7869075 DOI: 10.1186/s13613-021-00810-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan. Methods We performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date. Results There were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 or on dialysis. The results were consistent before and after propensity score matching. Conclusions Levosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m2 was not necessarily considered a contraindication for levosimendan in these patients.
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Affiliation(s)
- Cze-Ci Chan
- Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Tso Lee
- Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Jing Ho
- Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Franco RA, de Almeida JP, Landoni G, Scheeren TWL, Galas FRBG, Fukushima JT, Zefferino S, Nardelli P, de Albuquerque Piccioni M, Arita ECTC, Park CHL, Cunha LCC, de Oliveira GQ, Costa IBSDS, Kalil Filho R, Jatene FB, Hajjar LA. Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial. Ann Intensive Care 2021; 11:15. [PMID: 33496877 PMCID: PMC7838231 DOI: 10.1186/s13613-021-00808-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801
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Affiliation(s)
- Rafael Alves Franco
- Intensive Care Unit, Cancer Institute (ICESP), University of Sao Paulo, São Paulo, Brazil
| | | | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center, Groningen, The Netherlands
| | | | - Julia Tizue Fukushima
- Intensive Care Unit, Cancer Institute (ICESP), University of Sao Paulo, São Paulo, Brazil
| | - Suely Zefferino
- Department of Anesthesiology, Heart Institute, University of Sao Paulo, São Paulo, Brazil
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | - Roberto Kalil Filho
- Department of Cardiology, Heart Institute (InCor), University of Sao Paulo, São Paulo, Brazil
| | - Fabio Biscegli Jatene
- Division of Cardiovascular Surgery, Heart Institute (InCor), University of Sao Paulo, São Paulo, Brazil
| | - Ludhmila Abrahão Hajjar
- Intensive Care Unit, Cancer Institute (ICESP), University of Sao Paulo, São Paulo, Brazil. .,Department of Cardiopneumology, Instituto Do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44-05403-900, São Paulo, SP, Brazil.
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34
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Krumpl G, Ulč I, Trebs M, Kadlecová P, Hodisch J. Pharmacodynamic and pharmacokinetic behavior of landiolol during dobutamine challenge in healthy adults. BMC Pharmacol Toxicol 2020; 21:82. [PMID: 33239108 PMCID: PMC7691079 DOI: 10.1186/s40360-020-00462-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background To study the pharmacokinetic and -dynamic behavior of landiolol in the presence of dobutamine in healthy subjects of European ancestry. Methods We conducted a single-center, prospective randomized study in 16 healthy subjects each receiving an infusion of dobutamine sufficient to increase heart rate by 30 bpm followed by a 60 min infusion of 10 μg/kg/min landiolol. Results Dobutamine-induced increases in heart rate were stable for at least 20 min before a 60 min landiolol- infusion was started. The dobutamine effects were rapidly antagonized by landiolol within 16 min. A further slight decrease in heart rate during 20–60 min of the landiolol infusion occurred as well. Upon termination of landiolol infusion, heart rate and blood pressure recovered rapidly in response to the persisting dobutamine infusion but did not return to the maximum values before landiolol infusion. The pharmacokinetic parameters of landiolol in presence of dobutamine showed a short half-life (3.5 min) and a low distribution volume (0.3 l/kg). No serious adverse events were observed. Conclusion Landiolol can antagonize the dobutamine-induced increases in heart rate and blood pressure in a fast way. A rapid bradycardic effect until steady-state plasma levels is followed by a slow heart rate reduction. The latter can be attributed to an early desensitization to dobutamine. Consequently, after termination of landiolol, the heart rate did not achieve maximum pre-landiolol values. The pharmacokinetics of landiolol during dobutamine infusion are similar when compared to short- and long-term data in Caucasian subjects. Landiolol in the given dose can thus serve as an antagonist of dobutamine-induced cardiac effects. Trial registration Registration number 2010–023311-34 at the EU Clinical Trials Register, registration date 2010-12-21.
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Affiliation(s)
- Günther Krumpl
- MRN Medical Research Network GmbH, Postgasse 11/22, A-1010, Vienna, Austria.
| | - Ivan Ulč
- Center for Pharmacology and Analysis (CEPHA) s.r.o, Plzeň, Czech Republic
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35
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Morrone D, Arbucci R, Wierzbowska-Drabik K, Ciampi Q, Peteiro J, Agoston G, Varga A, Camarozano AC, Boshchenko A, Ryabova T, Dekleva M, Simova I, Lowenstein Haber DM, Tesic M, Boskovic N, Djordjevic-Dikic A, Beleslin B, D'Alfonso MG, Mori F, Rodrìguez-Zanella H, Kasprzak JD, Cortigiani L, Lattanzi F, Scali MC, Torres MAR, Daros CB, de Castro E Silva Pretto JL, Gaibazzi N, Zagatina A, Zhuravskaya N, Amor M, Mieles PEV, Merlo PM, Monte I, D'Andrea A, Re F, Di Salvo G, Merli E, Lorenzoni V, De Nes M, Paterni M, Limongelli G, Prota C, Citro R, Colonna P, Villari B, Antonini-Canterin F, Carpeggiani C, Lowenstein J, Picano E. Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes. Int J Cardiovasc Imaging 2020; 37:953-964. [PMID: 33057991 DOI: 10.1007/s10554-020-02071-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = - 0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.
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Affiliation(s)
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Jesus Peteiro
- CHUAC- Complexo Hospitalario Universitario A Coruna- University of A Coruna, La Coruna, Spain
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Ana Cristina Camarozano
- Hospital de Clinicas UFPR, Medicine Department, Federal University of Paranà, Curitiba, Brazil
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Milica Dekleva
- Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade, Serbia
| | - Iana Simova
- Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | | | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Maria Grazia D'Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Firenze, Italy
| | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Fabio Lattanzi
- Cardiothoracic Department, University of Pisa, Pisa, Italy
| | | | - Marco A R Torres
- Hospital de Clinicas de Porto Alegre - Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | | | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, St Petersburg, Russian Federation
| | - Nadezhda Zhuravskaya
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, St Petersburg, Russian Federation
| | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | | | | | - Ines Monte
- Echocardiography Lab, Cardio-Thorax-Vascular Department, "Policlinico Vittorio Emanuele", Catania University, Catania, Italy
| | | | - Federica Re
- Cardiology Division, Ospedale San Camillo, Rome, Italy
| | - Giovanni Di Salvo
- Cardiology Division, Pediatric Cardiology Department, Brompton Hospital, Imperial College of London, London, UK
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, Ravenna, Italy
| | | | - Michele De Nes
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Marco Paterni
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy
| | | | - Costantina Prota
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital "San Giovanni Di Dio e Ruggi D'Aragona", Salerno, Italy.,Italian Society of Echocardiography and Cardiovascular Imaging, Rome, Italy
| | - Paolo Colonna
- Italian Society of Echocardiography and Cardiovascular Imaging, Rome, Italy.,Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
| | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Francesco Antonini-Canterin
- Italian Society of Echocardiography and Cardiovascular Imaging, Rome, Italy.,Cardiac Prevention and Rehabilitation Unit, Highly Specialized Rehabilitation Hospital Motta Di Livenza, Treviso, Italy
| | - Clara Carpeggiani
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Eugenio Picano
- Biomedicine Department, Institute of Clinical Physiology, CNR, Pisa, Italy.
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Bolelli K, Ertan-Bolelli T, Unsalan O, Altunayar-Unsalan C. Fenoterol and dobutamine as SARS-CoV-2 main protease inhibitors: A virtual screening study. J Mol Struct 2021; 1228:129449. [PMID: 33071354 DOI: 10.1016/j.molstruc.2020.129449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/19/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
Global health is under heavy threat by a worldwide pandemic caused by a new type of coronavirus (COVID-19) since its rapid spread in China in 2019 [1]. Currently, there are no approved specific drugs and effective treatment for COVID-19 infection, but several available drugs are known to facilitate tentative treatment. Since drug design, development and testing procedures are time-consuming [2], [1], [2], [3], virtual screening studies with the aid of available drug databases take the initiative at this point and save the time. Besides, drug repurposing strategies promises to identify new agents for the novel diseases in a time-critical fashion. In this study, we used structure based virtual screening method on FDA approved drugs and compounds in clinical trials. As a result of this study we choose three most prominent compounds for further studies. Here we show that these three compounds (dobutamine and its two derivatives) can be considered as promising inhibitors for SARS-CoV-2 main protease and results also demonstrate the possible interactions of dobutamine and its derivatives with SARS-CoV-2 main protease (6W63) [6]. Our efforts in this work directly address current urgency of a new drug discovery against COVID-19.
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Rovere G, Meduri A, Savino G, Flammia FC, Lo Piccolo F, Carafa MRP, Larici AR, Natale L, Merlino B, Marano R. Practical instructions for using drugs in CT and MR cardiac imaging. Radiol Med 2020; 126:356-364. [PMID: 32833196 DOI: 10.1007/s11547-020-01261-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.
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Affiliation(s)
- Giuseppe Rovere
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Agostino Meduri
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesco Ciriaco Flammia
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Lo Piccolo
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Rachele Pia Carafa
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Marano
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
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Townsend DJ, Mala B, Hughes E, Hussain R, Siligardi G, Fullwood NJ, Middleton DA. Circular Dichroism Spectroscopy Identifies the β-Adrenoceptor Agonist Salbutamol As a Direct Inhibitor of Tau Filament Formation in Vitro. ACS Chem Neurosci 2020; 11:2104-2116. [PMID: 32520518 DOI: 10.1021/acschemneuro.0c00154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Potential drug treatments for Alzheimer's disease (AD) may be found by identifying compounds that block the assembly of the microtubule-associated protein tau into neurofibrillar tangles associated with neuron destabilization and cell death. Here, a small library of structurally diverse compounds was screened in vitro for the ability to inhibit tau aggregation, using high-throughput synchrotron radiation circular dichroism as a novel tool to monitor the structural changes in the protein as it assembles into filaments. The catecholamine epinephrine was found to be the most effective tau aggregation inhibitor of all 88 screened compounds. Subsequently, we tested chemically similar phenolamine drugs from the β-adrenergic receptor agonist class, using conventional circular dichroism spectroscopy, thioflavin T fluorescence, and transmission electron microscopy. Two compounds, salbutamol and dobutamine, used widely in the treatment of respiratory and cardiovascular disease, impede the aggregation of tau in vitro. Dobutamine reduces both the rate and yield of tau filament formation over 24 h; however, it has little effect on the structural transition of tau into β-sheet structures over 24 h. Salbutamol also reduces the yield and rate of filament formation and additionally inhibits tau's structural change into β-sheet-rich aggregates. Salbutamol has a good safety profile and a half-life that facilitates permeation through the blood-brain barrier and could represent an expediated approach to developing AD therapeutics. These results provide the motivation for the in vivo evaluation of pre-existing β-adrenergic receptor agonists as a potential therapy for AD through the reduction of tau deposition.
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Affiliation(s)
- David J Townsend
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - Barbora Mala
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - Eleri Hughes
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - Rohanah Hussain
- Diamond House, Harwell Science & Innovation Campus, Diamond Light Source Ltd., Didcot OX11 ODE, United Kingdom
| | - Giuliano Siligardi
- Diamond House, Harwell Science & Innovation Campus, Diamond Light Source Ltd., Didcot OX11 ODE, United Kingdom
| | - Nigel J. Fullwood
- Biomedical and Life Sciences, Lancaster University, Lancaster LA1 4YG, United Kingdom
| | - David A. Middleton
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom
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Abstract
Pathological interplay between the heart and kidneys is widely encountered in heart failure (HF) and is linked to worse prognosis and quality of life. Inotropes, along with diuretics and vasodilators, are a core medical response to HF but decompensated patients who need inotropic support often present with an acute worsening of renal function. The impact of inotropes on renal function is thus potentially an important influence on the choice of therapy. There is currently relatively little objective data available to guide the selection of inotrope therapy but recent direct observations on the effects of levosimendan and milrinone on glomerular filtration favour levosimendan. Other lines of evidence indicate that in acute decompensated HF levosimendan has an immediate renoprotective effect by increasing renal blood flow through preferential vasodilation of the renal afferent arterioles and increases in glomerular filtration rate: potential for renal medullary ischaemia is avoided by an offsetting increase in renal oxygen delivery. These indications of a putative reno-protective action of levosimendan support the view that this calcium-sensitizing inodilator may be preferable to dobutamine or other adrenergic inotropes in some settings by virtue of its renal effects. Additional large studies will be required, however, to clarify the renal effects of levosimendan in this and other relevant clinical situations, such as cardiac surgery.
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Affiliation(s)
- Endre Zima
- Cardiac Intensive Care, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dimitrios Farmakis
- Department of Cardiology, University of Cyprus Medical School, Nicosia, Cyprus
| | - Piero Pollesello
- Critical Care Proprietary Products, CO, Orion Pharma, PO Box 65, FIN-02101 Espoo, Finland
| | - John T Parissis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
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40
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Kossaify A, Bassil E, Kossaify M. Stress Echocardiography: Concept and Criteria, Structure and Steps, Obstacles and Outcomes, Focused Update and Review. Cardiol Res 2020; 11:89-96. [PMID: 32256915 PMCID: PMC7092766 DOI: 10.14740/cr851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 01/28/2020] [Indexed: 01/06/2023] Open
Abstract
Stress echocardiography (SEC) is a technique established more than 35 years ago; however, it is still poorly implemented in many countries and institutions, and this reluctance may be related to many obstacles such as operator skills, lack of awareness or institutional policy. Stress echo was initially used for assessing coronary artery disease (CAD), with respect to myocardial viability, using wall motion response; however, current use of stress echo extends beyond CAD, such as valvular heart disease and diastolic stress test. Dobutamine is a commonly used agent when pharmaceutical approach is implemented. With regard to CAD, there are four stress responses: normal, ischemic, viable and necrotic. A low dose dobutamine protocol is recommended in patients with baseline wall motion abnormalities, and a very low dose dobutamine is used in low flow low gradient aortic stenosis in order to check the flow and contractility reserve. Of note, respecting protocols, indications and contraindications are important to avoid or minimize risks of complications during the procedure. This article presents a focused update and review regarding SEC, along with an overview of the different indications, structures and steps, and obstacles and outcomes; also the article aims to highlight more awareness and sensitization on this useful technique.
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Affiliation(s)
- Antoine Kossaify
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
| | - Elie Bassil
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
| | - Mikhael Kossaify
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
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Buttà C, Roberto M, Tuttolomondo A, Petrantoni R, Miceli G, Zappia L, Pinto A. Old and New Drugs for Treatment of Advanced Heart Failure. Curr Pharm Des 2019; 26:1571-1583. [PMID: 31878852 DOI: 10.2174/1381612826666191226165402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/23/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Advanced heart failure (HF) is a progressive disease with high mortality and limited medical therapeutic options. Long-term mechanical circulatory support and heart transplantation remain goldstandard treatments for these patients; however, access to these therapies is limited by the advanced age and multiple comorbidities of affected patients, as well as by the limited number of organs available. METHODS Traditional and new drugs available for the treatment of advanced HF have been researched. RESULTS To date, the cornerstone for the treatment of patients with advanced HF remains water restriction, intravenous loop diuretic therapy and inotropic support. However, many patients with advanced HF experience loop diuretics resistance and alternative therapeutic strategies to overcome this problem have been developed, including sequential nephron blockade or use of the hypertonic saline solution in combination with high-doses of furosemide. As classic inotropes augment myocardial oxygen consumption, new promising drugs have been introduced, including levosimendan, istaroxime and omecamtiv mecarbil. However, pharmacological agents still remain mainly short-term or palliative options in patients with acute decompensation or excluded from mechanical therapy. CONCLUSION Traditional drugs, especially when administered in combination, and new medicaments represent important therapeutic options in advanced HF. However, their impact on prognosis remains unclear. Large trials are necessary to clarify their therapeutic potential and prognostic role in these fragile patients.
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Affiliation(s)
- Carmelo Buttà
- Unità Operativa Complessa, Cardiologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy
| | - Marco Roberto
- Servizio di Cardiologia, Cardiocentro Ticino Lugano, Lugano, Switzerland
| | - Antonino Tuttolomondo
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
| | - Rossella Petrantoni
- Pronto Soccorso, Fondazione Istituto G. Giglio di Cefalù, 90015 Cefalù PA, Italy
| | - Giuseppe Miceli
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Zappia
- Unità Operativa Complessa, Cardiologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy
| | - Antonio Pinto
- Unità Operativa Complessa, Medicina Interna e con Stroke Care, Dipartimento di Promozione della Salute, Materno-infantile, Medicina Interna e Specialistica di Eccellenza, Università degli Studi di Palermo, Palermo, Italy
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Lorthongpanich C, Thumanu K, Tangkiettrakul K, Jiamvoraphong N, Laowtammathron C, Damkham N, U-Pratya Y, Issaragrisil S. YAP as a key regulator of adipo-osteogenic differentiation in human MSCs. Stem Cell Res Ther 2019; 10:402. [PMID: 31852542 PMCID: PMC6921580 DOI: 10.1186/s13287-019-1494-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/28/2019] [Accepted: 11/13/2019] [Indexed: 02/08/2023] Open
Abstract
Background Mesenchymal stem cells (MSCs) are multipotent stem cells that are able to differentiate into several cell types, including cartilage, fat, and bone. As a common progenitor, MSC differentiation has to be tightly regulated to maintain the balance of their differentiation commitment. It has been reported that the decision process of MSCs into fat and bone cells is competing and reciprocal. Several factors have been suggested as critical factors that affect adipo-osteogenic decision, including melatonin and smad4. Yes-associated protein (YAP) is an important effector protein in the Hippo signaling pathway that acts as a transcriptional regulator by activating the transcription of the genes involved in cell proliferation and anti-apoptosis. The non-canonical role of YAP in regulating bone homeostasis by promoting osteogenesis and suppressing adipogenesis was recently demonstrated in a mouse model. However, it is unclear whether YAP is also crucial for modulating human MSC differentiation to fat and bone. Methods The expression level of YAP during MSC differentiation was modulated using pharmaceutical molecule and genetic experiments through gain- and loss-of-function approaches. Results We demonstrated for the first time that YAP has a non-canonical role in regulating the balance of adipo-osteogenic differentiation of human MSCs. The result from synchrotron radiation-based Fourier transform infrared (FTIR) microspectroscopy showed unique metabolic fingerprints generated from YAP-targeted differentiated cells that were clearly distinguished from non-manipulated control. Conclusions These results, thus, identify YAP as an important effector protein that regulates human MSC differentiation to fat and bone and suggests the use of FTIR microspectroscopy as a promising technique in stem cell research.
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Affiliation(s)
- Chanchao Lorthongpanich
- Siriraj Center of Excellence for Stem Cell Research, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Kanjana Thumanu
- Synchrotron Light Research Institute (Public Organization), Nakhon Ratchasima, Thailand
| | - Kantpitchar Tangkiettrakul
- Siriraj Center of Excellence for Stem Cell Research, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Nittaya Jiamvoraphong
- Siriraj Center of Excellence for Stem Cell Research, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Chuti Laowtammathron
- Siriraj Center of Excellence for Stem Cell Research, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Nattaya Damkham
- Siriraj Center of Excellence for Stem Cell Research, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.,Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yaowalak U-Pratya
- Siriraj Center of Excellence for Stem Cell Research, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.,Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surapol Issaragrisil
- Siriraj Center of Excellence for Stem Cell Research, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.,Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Bangkok Hematology Center, Wattanosoth Hospital, BDMS Center of Excellence for Cancer, Bangkok, Thailand
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43
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Farmakis D, Agostoni P, Baholli L, Bautin A, Comin-Colet J, Crespo-Leiro MG, Fedele F, García-Pinilla JM, Giannakoulas G, Grigioni F, Gruchała M, Gustafsson F, Harjola VP, Hasin T, Herpain A, Iliodromitis EK, Karason K, Kivikko M, Liaudet L, Ljubas-Maček J, Marini M, Masip J, Mebazaa A, Nikolaou M, Ostadal P, Põder P, Pollesello P, Polyzogopoulou E, Pölzl G, Tschope C, Varpula M, von Lewinski D, Vrtovec B, Yilmaz MB, Zima E, Parissis J. A pragmatic approach to the use of inotropes for the management of acute and advanced heart failure: An expert panel consensus. Int J Cardiol 2019; 297:83-90. [PMID: 31615650 DOI: 10.1016/j.ijcard.2019.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/14/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022]
Abstract
Inotropes aim at increasing cardiac output by enhancing cardiac contractility. They constitute the third pharmacological pillar in the treatment of patients with decompensated heart failure, the other two being diuretics and vasodilators. Three classes of parenterally administered inotropes are currently indicated for decompensated heart failure, (i) the beta adrenergic agonists, including dopamine and dobutamine and also the catecholamines epinephrine and norepinephrine, (ii) the phosphodiesterase III inhibitor milrinone and (iii) the calcium sensitizer levosimendan. These three families of drugs share some pharmacologic traits, but differ profoundly in many of their pleiotropic effects. Identifying the patients in need of inotropic support and selecting the proper inotrope in each case remain challenging. The present consensus, derived by a panel meeting of experts from 21 countries, aims at addressing this very issue in the setting of both acute and advanced heart failure.
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Affiliation(s)
- Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus; Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dept. of Clinical Sciences and Community Health - Cardiovascular Section, University of Milan, Milan, Italy
| | - Loant Baholli
- Medizinische Klinik Mitte - Schwerpunkte Kardiologie und Internistische Intensivmedizin, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Andrei Bautin
- Department of Anesthesiology, Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Josep Comin-Colet
- Heart Diseases Institute, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario de A Coruña (CHUAC)-CIBERCV, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña (UDC), A Coruña, Spain
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, 'La Sapienza' University of Rome, Rome, Italy
| | - Jose Manuel García-Pinilla
- Heart Failure and Familial Cardiopathies Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Francesco Grigioni
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Finn Gustafsson
- Cardiology Dept., Rigshospitalet, University of Copenhagen, Copengahen, Denmark
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Antoine Herpain
- Department of Intensive Care, Experimental Laboratory of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Efstathios K Iliodromitis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kristjan Karason
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matti Kivikko
- Department of Cardiology S7, Jorvi Hospital, Espoo, Finland; Critical Care Proprietary Products, Orion Pharma, Espoo, Finland
| | - Lucas Liaudet
- Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois et Faculté de Biologie et Médecine, Lausanne, Switzerland
| | - Jana Ljubas-Maček
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Marco Marini
- Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy
| | - Josep Masip
- Intensive Care Dpt. Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain; Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France
| | - Maria Nikolaou
- Department of Cardiology, General Hospital "Sismanogleio-Amalia Fleming", Greece
| | - Petr Ostadal
- Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
| | - Pentti Põder
- Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia
| | - Piero Pollesello
- Critical Care Proprietary Products, Orion Pharma, Espoo, Finland
| | - Eftihia Polyzogopoulou
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerhard Pölzl
- Universitätsklinik für Innere Medizin III, Medizinsche Universität, Innsbruck, Austria
| | - Carsten Tschope
- Charité, University Medicine Berlin, Campus Virchow Klinikum (CVK), Department of Cardiology, Germany; BCRT, Berlin Institute of Health for Center for Regenerative Therapies, Berlin, Germany
| | - Marjut Varpula
- Department of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Dirk von Lewinski
- Department of Cardiology, Myokardiale Energetik und Metabolismus Research Unit, Medical University, Graz, Austria
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - John Parissis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Seegmiller JC, Larson KA, Saenger AK. An investigation of enzymatic creatinine interference in a patient receiving dopamine and dobutamine. Clin Biochem 2019; 73:115-117. [PMID: 31398309 DOI: 10.1016/j.clinbiochem.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/15/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND A laboratory investigation was initiated after a renal failure patient had a 2.18 mg/dL decrease in serum creatinine, which was not explained through medical intervention. The investigation revealed specimens providing questionably low results had been collected from a peripherally inserted central catheter (PICC) line. METHODS Patient specimens and serum pools were analyzed by the Siemens Vista enzymatic creatinine measurement procedure. A simulation of the patient's infusion protocol examined potential PICC line carryover and specimen collection technique. RESULTS A simultaneously collected specimen set, arterial line and PICC line, yielded a difference of 1.86 mg/dL. Infusion and collection simulation studies suggested the most likely scenario was the infusion pump was not shut off while the specimen collection occurred and contaminated the specimen. CONCLUSION Providers should be aware of erroneously low creatinine results when administering catecholamine drugs and collecting specimens through the same catheter. The mechanism of specimen contamination is consistent with a siphoning effect from one lumen to the other during collection with the infusion pumps still running.
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Affiliation(s)
- Jesse C Seegmiller
- Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, United States; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States.
| | - Kathy A Larson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Amy K Saenger
- Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, United States; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
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Cholley B, Caruba T. Should we keep levosimendan in our pharmacies? Yes, undoubtedly! Anaesth Crit Care Pain Med 2019; 38:211-212. [PMID: 31076141 DOI: 10.1016/j.accpm.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Bernard Cholley
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Thibaut Caruba
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Deshotels MR, Hyman DA, Yang Y, Birnbaum Y. The significance of electrocardiographic changes without echocardiographic evidence of segmental wall motion abnormalities in patients undergoing dobutamine stress echocardiography. J Electrocardiol 2019; 63:164-166. [PMID: 31005263 DOI: 10.1016/j.jelectrocard.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/27/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Abstract
Ischemic ECG changes during dobutamine stress echocardiography (DSE) have been reported to have low sensitivity and specificity for detecting myocardial ischemia in the absence of wall motion abnormalities on echocardiography. We present a case of a renal transplant candidate with severe multivessel disease who had ST depressions without any wall motion abnormalities on DSE. Certain studies have shown the sensitivity of DSE is lower in patients with left ventricular hypertrophy and/or end stage renal disease, but the significance of ischemic ECG changes with no evidence of wall motion abnormalities in these patients has not been well studied.
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Affiliation(s)
- Matthew R Deshotels
- The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel A Hyman
- The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Yang Yang
- The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Yochai Birnbaum
- The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, TX, USA; The Texas Heart institute, Baylor St. Luke's Medical Center, Houston, TX, USA.
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47
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Takkis K, Veigure R, Metsvaht T, Hallik M, Ilmoja ML, Starkopf J, Kipper K. A sensitive method for the simultaneous UHPLC-MS/MS analysis of milrinone and dobutamine in blood plasma using NH 4F as the eluent additive and ascorbic acid as a stabilizer. Clin Mass Spectrom 2019; 12:23-29. [PMID: 34841076 PMCID: PMC8620135 DOI: 10.1016/j.clinms.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this work was to develop and validate an HPLC-MS/MS method suitable for quantifying two important cardiovascular drugs, milrinone and dobutamine, in neonatal and paediatric patients' blood plasma samples. Sufficiently low LLOQ levels were required to obtain adequate pharmacokinetic data for the evaluation of optimal dosing. Since the specifics of the patient group set some restrictions on the available sample volume, the method was designed to use only 20 µL of plasma for the analysis. Analytes were separated chromatographically in a biphenyl column using a conventional water-methanol-formic acid eluent with the addition of ammonium fluoride. The latter provided a significant signal enhancement in positive ion mode detection for both analytes allowing the LLOQ to reach below 1 ng/mL. Matrix matched calibration was linear in the range of 1-300 ng/mL, between-run accuracy remained within 107-115%, and precision within 4.8-7.4% for both analytes over the calibration range (including LLOQ level). Dobutamine degradation in plasma samples was prevented by the usage of ascorbic acid. The method was applied to plasma samples of neonates from two pharmacokinetic/pharmacodynamics studies (n = 38).
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Key Words
- Ammonium fluoride
- Ascorbic acid
- CCBV, calculated circulating blood volume
- CPD, citrate phosphate dextrose
- CV, coefficient of variation
- Dobutamine
- EDTA, ethylenediaminetetraacetic acid
- EMA, European Medicines Agency
- ESI, electrospray ionisation
- EU, European Union
- IS, internal standard
- LC, liquid chromotography
- LLOQ, lowest limit of quantification
- MED, quality control sample at the concentration between ULOQ and 3xLLOQ
- MF, matrix factor
- MRM, multiple reaction monitoring
- MS, mass spectrometry
- MS/MS, tandem mass spectrometry
- MeOH, methanol
- Milrinone
- NH4F, ammonium fluoride
- PCR, polymerase chain reaction
- PD, pharmacodynamics
- PK, pharmacokinetics
- QC, quality control sample
- Signal enhancement
- TOC, total organic carbon
- UHPLC, ultra-high performance liquid chromotography
- UHPLC-MS/MS
- ULOQ, upper limit of quantification
- cAMP, cyclic 3,5 adenosine monophosphate
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Affiliation(s)
- Kalev Takkis
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
- Analytical Services International, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Rūta Veigure
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
| | - Tuuli Metsvaht
- Tartu University Hospital, Lunini 6, 51014 Tartu, Estonia
| | - Maarja Hallik
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Tartu University, L. Puusepa 8 - G1. 209, 50406 Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tallinn Children's Hospital, Tervise 28, 13419 Tallinn, Estonia
| | - Mari-Liis Ilmoja
- Department of Anaesthesiology and Intensive Care, Tallinn Children's Hospital, Tervise 28, 13419 Tallinn, Estonia
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Tartu University, L. Puusepa 8 - G1. 209, 50406 Tartu, Estonia
- Clinic of Anaesthesiology an Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Karin Kipper
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
- Analytical Services International, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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Abstract
This article presents the case of a 22-year-old male patient with cardiomyopathy associated with a long history of methamphetamine abuse. Echocardiography revealed a dilated cardiomyopathy with highly reduced systolic pump function and severe mitral valve regurgitation. Inotropic treatment and MitraClip® (Abbott Vascular, Santa Clara, CA, USA) implantation resulted in enhancement of hemodynamics. The rising prevalence of methamphetamine abuse should give reason to raise awareness for the diagnostic work-up and patient history particularly in cases of unexplained cardiomyopathy in young patients.
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Affiliation(s)
- D M Schwab
- Klinik für Kardiologie, Angiologie und Pneumologie, Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - H A Katus
- Klinik für Kardiologie, Angiologie und Pneumologie, Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - P W Raake
- Klinik für Kardiologie, Angiologie und Pneumologie, Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
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Sakaguchi Y, Ozaki K, Takano T, Namba H, Tanaka K, Yanagawa T, Ozawa T, Minamino T. Dynamic left ventricular outflow tract obstruction complicated with takotsubo cardiomyopathy: The acute phase of takotsubo cardiomyopathy manifests latent left ventricular outflow tract obstruction. J Cardiol Cases 2018; 18:60-4. [PMID: 30279912 DOI: 10.1016/j.jccase.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 11/20/2022] Open
Abstract
Dynamic left ventricular (LV) outflow tract (LVOT) obstruction is sometimes complicated with takotsubo cardiomyopathy (TC). The present case involves a 70-year-old woman with chest discomfort. Seven years earlier, transthoracic echocardiography revealed LVOT obstruction due to a sigmoid-shaped septum. She underwent urgent cardiac catheterization for suspected acute coronary syndrome. She was diagnosed as having TC with LVOT obstruction. After undergoing conservative treatment, her LV function normalized and the LVOT obstruction resolved. After the LV wall motion normalized, administering an intravenous infusion of dobutamine again provoked LVOT obstruction. In this situation, the presence of TC manifested latent LVOT obstruction. <Learning objective: Although dynamic left ventricular outflow tract (LVOT) obstruction is the important compication of takotsubo cardiomyopaty (TC), the mechanism of LVOT obstruction remains unclear. This case had latent LVOT obstruction due to sigmoid-shaped septum, and LVOT obstruction might be manifested in the acute phase of TC. This phenomenon has potential for mechanism of LVOT obstruction complicated with TC.>.
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Abstract
Inotropes are medications that improve the contractility of the heart and are used in patients with low cardiac output or evidence of end-organ dysfunction. Since their initial discovery, inotropes have held promise in alleviating symptoms and potentially increasing longevity in such patients. Decades of intensive study have further elucidated the benefits and risks of using inotropes. In this article, the authors discuss the history of inotropes, their indications, mechanism of action, and current guidelines pertaining to their use in heart failure. The authors provide insight into their appropriate use and related shortcomings and the practical aspects of inotrope use.
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Affiliation(s)
- Mahazarin Ginwalla
- Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - David S Tofovic
- Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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