Vasopressin and ischaemic heart disease: more than coronary vasoconstriction?
During advanced vasodilatory shock, arginine vasopressin (AVP) is increasingly used to restore blood pressure and thus to reduce catecholamine requirements. The AVP-related rise in mean arterial pressure is due to systemic vasoconstriction, which, depending on the infusion rate, may also reduce coronary blood flow despite an increased coronary perfusion pressure. In a murine model of myocardial ischaemia, Indrambarya and colleagues now report that a 3-day infusion of AVP decreased the left ventricular ejection fraction, ultimately resulting in increased mortality, and thus compared unfavourably with a standard treatment using dobutamine. The AVP-related impairment myocardial dysfunction did not result from the increased left ventricular afterload but from a direct effect on cardiac contractility. Consequently, the authors conclude that the use of AVP should be cautioned in patients with underlying cardiac disease.
Asfar
Pierre
P
Laboratoire HIFIH UPRES-EA 3859, IFR 132, Université d'Angers, Département de Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Universitaire, 49933 Angers Cedex 09, France. piasfar@chu-angers.fr
Radermacher
Peter
P
D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000075202:Contraindications; D006801:Humans; D017202:Myocardial Ischemia / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin