title: Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding.
abstract: Right ventricular (RV) failure due to chronic pressure overload is a main determinant of outcome in congenital heart disease. Medical management is challenging because not only contractility but also the interventricular relationship is important for increasing cardiac output. This study evaluated the effect of milrinone alone and in combination with epinephrine or dopamine on hemodynamics, ventricular performance, and the interventricular relationship. RV failure was induced in 21 Danish landrace pigs by pulmonary artery banding. After 10 wk, animals were reexamined using biventricular pressure-volume conductance catheters. The maximum pressure in the RV increased by 113% (P < 0.0001) and end-diastolic volume by 43% (P < 0.002), while left ventricular (LV) pressure simultaneously decreased (P = 0.006). Concomitantly, mean arterial pressure (MAP; -16%, P = 0.01), cardiac index (CI; -23%, P < 0.0001), and mixed venous oxygen saturation (SvO2 ; -40%, P < 0.0001) decreased. Milrinone increased CI (11%, P = 0.008) and heart rate (HR; 21%, P < 0.0001). Stroke volume index (SVI) decreased (7%, P = 0.03), although RV contractility was improved. The addition of either epinephrine or dopamine further increased CI and HR in a dose-dependent manner but without any significant differences between the two interventions. A more pronounced increase in biventricular contractility was observed in the dopamine-treated animals. LV volume was reduced in both the dopamine and epinephrine groups with increasing doses In the failing pressure overloaded RV, milrinone improved CI and increased contractility. Albeit additional dose-dependent effects of both epinephrine and dopamine on CI and contractility, neither of the interventions improved SVI due to reduced filling of the LV.
authors.affiliation: Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; and.
authors.forename: Janus Adler
authors.identifier: http://orcid.org/0000-0001-8318-0323
authors.initials: JA
authors.lastname: Hyldebrandt
authors.affiliation: Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Sivén
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; and.
authors.forename: Peter
authors.initials: P
authors.lastname: Agger
authors.affiliation: Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark;
authors.forename: Christian Alcaraz
authors.initials: CA
authors.lastname: Frederiksen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark;
authors.forename: Johan
authors.initials: J
authors.lastname: Heiberg
authors.affiliation: Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark;
authors.forename: Kristian Borup
authors.initials: KB
authors.lastname: Wemmelund
authors.affiliation: Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Hanne.berg.ravn@regionh.dk.
authors.forename: Hanne Berg
authors.initials: HB
authors.lastname: Ravn
mesh_terms: D000818:Animals; D002316:Cardiotonic Agents / Q000494:pharmacology*; D004195:Disease Models, Animal; D004298:Dopamine / Q000494:pharmacology*; D004837:Epinephrine / Q000494:pharmacology*; D006333:Heart Failure; D006352:Heart Ventricles / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D020105:Milrinone / Q000494:pharmacology*; D011651:Pulmonary Artery / Q000601:surgery; D013318:Stroke Volume / Q000187:drug effects; D013552:Swine; D013566:Sympathomimetics / Q000494:pharmacology*; D018497:Ventricular Dysfunction, Right; D016277:Ventricular Function, Left / Q000187:drug effects*; D016278:Ventricular Function, Right / Q000187:drug effects*
chemical_list: D002316:Cardiotonic Agents; D013566:Sympathomimetics; D020105:Milrinone; D004298:Dopamine; D004837:Epinephrine
keywords: dopamine; epinephrine; heart failure; hemodynamics; milrinone; pulmonary hypertension; right ventricular failure