Effects of enoximone and R 80122, a new selective phosphodiesterase III inhibitor, on hemodynamics and myocardial energetics in patients with ischemic heart disease.
The present study was designed to compare the effects of enoximone and R 80122, a highly selective phosphodiesterase (PDE) III inhibitor, on left ventricular hemodynamics and myocardial blood flow and metabolism in patients with coronary artery disease. Twenty male, anesthetized patients, ASA physical status III, were studied before they underwent coronary artery bypass grafting (CABG) surgery. They were allocated randomly to receive either 0.3 mg/kg R 80122 (Group 1) or 1 mg/kg enoximone (Group 2) intravenously (IV). All patients were taking maintenance doses of either beta-receptor antagonists or calcium-channel-blocking drugs and nitrates. After receiving flunitrazepam, 2 mg orally, anesthesia was induced with fentanyl, midazolam, and pancuronium IV. Following control measurements after the induction of anesthesia, the PDE III inhibitor was infused over 2 min and measurements were repeated 5, 30, and 60 min after drug administration. There were no external stimuli to the patients during any of the measurement periods. R 80122 and enoximone decreased mean arterial pressure (MAP) by 20% and systemic vascular resistance (SVR) by 36% and 38%, respectively, while cardiac index (CI) increased by 27% and 30%, respectively. There were increases in heart rate (HR) by 10% and 19%, respectively, and in contractility (dp/dtmax) by 18% and 38%, respectively. Coronary perfusion pressure (CPP) decreased by 23% and 22%, respectively, and coronary vascular resistance (CVR) by 38% and 21%, respectively. Myocardial blood flow (MBF) and myocardial oxygen uptake (MVO2) increased in both groups, the increase in MBF being statistically significant (+34%) only in Group 1, whereas the changes in myocardial metabolism were not significant in either group.(ABSTRACT TRUNCATED AT 250 WORDS)
Stephan
H
H
Department of Anesthesiology, Emergency Medicine and Intensive Care, University of Goettingen, Germany.
Kazmaier
S
S
Hoeft
A
A
Sonntag
H
H
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000494:pharmacology*; D002395:Catecholamines / Q000097:blood; D003326:Coronary Circulation / Q000187:drug effects; D017335:Enoximone / Q000494:pharmacology*; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology*; D007773:Lactates / Q000096:biosynthesis; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology*; D011799:Quinazolines / Q000494:pharmacology*; D014665:Vasodilator Agents / Q000494:pharmacology; D016277:Ventricular Function, Left / Q000187:drug effects
D002316:Cardiotonic Agents; D002395:Catecholamines; D007093:Imidazoles; D007773:Lactates; D010726:Phosphodiesterase Inhibitors; D011799:Quinazolines; D014665:Vasodilator Agents; C076518:R 80122; D019344:Lactic Acid; D017335:Enoximone