title: Effects of dobutamine on left ventricular performance and myocardial metabolic demands in patients with ischemic heart disease.
abstract: Sixteen patients with coronary artery disease undergoing cardiac catheterization were studied. Eleven had previous infarcts and the patients were divided into two groups: In group I were 7 patients with no left ventricular dysfunction, no increase in ventricular size, or symptoms of congestive failure; group II included 9 patients with ventricular dysfunction, increased ventricular size, and 7 of the 9 had congestive failure. Each patient underwent a continuous infusion of dobutamine from 2.5 to 10 micrograms/kg min-1 with dosage increments of 2.5 micrograms/kg at 15-minute intervals. Systemic and coronary hemodynamic measurements were obtained at the end of the 5 and 10 micrograms/kg min-1 infusion doses. Left ventricular performance improved (higher cardiac index, left ventricular stroke work index and mean systolic ejection rate, and lower left ventricular end-diastolic pressure), while heart rate, mean arterial pressure, and coronary sinus blood flow increased after dobutamine in the 16 patients. While patients in both groups had a rise in cardiac index, a reduction in left ventricular end-diastolic pressure, an unchanged mean arterial pressure and a rise in coronary blood flow, only patients in group I had a significant increase in heart rate, and only patients in group II had significant increases in left ventricular stroke work index and mean systolic ejection rate, and a significant reduction in systemic vascular resistance. Left ventricular oxygen consumption did not increase significantly in either group. However, 5 patients showed a decreased myocardial lactate extraction after 10 micrograms/kg min-1 of intravenous dobutamine, 3 from group I and 2 from group II.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D002395:Catecholamines / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D004280:Dobutamine / Q000627:therapeutic use*; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007773:Lactates / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism*; D010101:Oxygen Consumption / Q000187:drug effects
chemical_list: D002395:Catecholamines; D007773:Lactates; D004280:Dobutamine