Evaluation of the anti-ischemic effects of D-ribose during dobutamine stress echocardiography: a pilot study.
D-Ribose, a pentose sugar, has shown to improve myocardial high-energy phosphate stores depleted by ischemia. This study investigated the ability of D-Ribose with low dose dobutamine to improve the contractile response of viable myocardium to dobutamine and to assess the efficacy of D-ribose in reducing stress-induced ischemia. Twenty-six patients with ischemic cardiomyopathy completed a two-day, randomized, double blind crossover trial comparing the effects of D-Ribose and placebo on regional wall motion. On the first study day, either D-Ribose or placebo was infused for 4.5 hours. Low (5 and 10 micro/kg/min) and subsequently, high (up to 50 micro/kg/min) dose dobutamine echocardiography was then performed. On the second study day, patients crossed over to the alternative article for a similar 4.5 hours infusion time period and underwent a similar evaluation. The wall motion response during low dose dobutamine was the same with D-Ribose and placebo in 77% of segments (203/263, Kappa = 0.37). In segments with discordant responses, more segments improved with D-Ribose than with placebo (41 vs. 19 segments, p = 0.006). With high dose dobutamine infusion, the wall motion response (ischemia vs. no ischemia) was the same with D-Ribose and placebo in 83% of interpretable segments (301/363, kappa = 0.244). In segments with discordant responses, there were more ischemic segments with placebo compared to D-Ribose (36 vs. 26, p = 0.253). Nineteen patients developed ischemia during the dobutamine and placebo infusion and 13 patients had ischemia during dobutamine and D-ribose infusion (p = 0.109). D-Ribose improved contractile responses to dobutamine in viable myocardium with resting dysfunction but had no significant effect in reducing the frequency of stress-induced wall motion abnormalities.
Sawada
Stephen G
SG
Krannert Institute of Cardiology, The Department of Medicine of the Indiana University School of Medicine, The Richard Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA. ssawada@iupui.edu
Lewis
Stephen
S
Kovacs
Roxanne
R
Khouri
Samer
S
Gradus-Pizlo
Irmina
I
St Cyr
John A
JA
Feigenbaum
Harvey
H
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004280:Dobutamine / Q000008:administration & dosage*; D004357:Drug Synergism; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D010865:Pilot Projects; D010919:Placebos; D012266:Ribose / Q000008:administration & dosage*
D002316:Cardiotonic Agents; D010919:Placebos; D004280:Dobutamine; D012266:Ribose