title: Triiodothyronine optimizes sheep ventriculoarterial coupling for work efficiency.
abstract: BACKGROUND
  Triiodothyronine (T3) administration after cardiopulmonary bypass has been shown to significantly improve cardiac performance. The present study was undertaken to elucidate the effects of T3, when administered as an intravenous bolus, on both cardiac energetics and stroke work-oxygen utilization (EW/LVVO2) efficiency.
  
  
  METHODS
  In both unstressed and stressed hearts, energetics were evaluated at baseline and 2 hours after intervention in an in vivo sheep preparation. In the first group (n = 5) sheep received saline vehicle. In the second group (n = 9) sheep received an intravenous bolus of 1.2 micrograms/kg of T3. In the third group (n = 7) sheep received a 2-hour intravenous infusion of dobutamine at a rate of 5 micrograms/kg/min.
  
  
  RESULTS
  In the unstressed heart, T3 improved cardiac function at no cost in oxygen consumption by decreasing afterload and hence improved EW/LVVO2 efficiency. In contrast, dobutamine improved unstressed cardiac function by increasing contractility at the cost of increased oxygen consumption and thus decreased EW/LVVO2 efficiency. Triiodothyronine optimized ventriculoarterial coupling for efficiency, but dobutamine optimized coupling for maximal work. In the stressed heart, T3 again improved EW/LVVO2 efficiency, but dobutamine had the opposite effect.
  
  
  CONCLUSIONS
  The bolus administration of T3 improves unstressed cardiac performance through optimization of ventriculoarterial coupling for EW/LVVO2 efficiency, primarily through vasodilation. Triiodothyronine also increases efficiency in the stressed heart. This study supports the use of T3 in cardiac operations to improve cardiac performance with no cost in oxygen consumption characteristic of inotropic agents.
authors.affiliation: Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA.
authors.forename: F V
authors.initials: FV
authors.lastname: DiPierro
authors.forename: J E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: E B
authors.initials: EB
authors.lastname: Lankford
authors.forename: D J
authors.initials: DJ
authors.lastname: Polidori
authors.forename: M A
authors.initials: MA
authors.lastname: Acker
authors.forename: J T
authors.initials: JT
authors.lastname: Streicher
authors.forename: T J
authors.initials: TJ
authors.lastname: Gardner
mesh_terms: D000818:Animals; D001158:Arteries / Q000187:drug effects / Q000502:physiology*; D002316:Cardiotonic Agents / Q000494:pharmacology; D003326:Coronary Circulation / Q000187:drug effects; D004280:Dobutamine / Q000494:pharmacology; D004548:Elasticity; D006439:Hemodynamics / Q000187:drug effects; D009200:Myocardial Contraction / Q000187:drug effects; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption / Q000187:drug effects; D012756:Sheep; D013318:Stroke Volume / Q000187:drug effects; D014284:Triiodothyronine / Q000494:pharmacology*; D014655:Vascular Resistance / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D002316:Cardiotonic Agents; D014284:Triiodothyronine; D004280:Dobutamine