title: Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in right heart failure after pulmonary regurgitation.
abstract: Right ventricular failure (RVF) secondary to pulmonary regurgitation (PR) impairs right ventricular (RV) function and interrupts the interventricular relationship. There are few recommendations for the medical management of severe RVF after prolonged PR. PR was induced in 16 Danish landrace pigs by plication of the pulmonary valve leaflets. Twenty-three pigs served as controls. At reexamination the effect of milrinone, epinephrine, and dopamine was evaluated using biventricular conductance and pulmonary catheters. Seventy-nine days after PR was induced, RV end-diastolic volume index (EDVI) had increased by 33% (P = 0.006) and there was a severe decrease in the load-independent measurement of contractility (PRSW) (-58%; P = 0.003). Lower cardiac index (CI) (-28%; P < 0.0001), mean arterial pressure (-15%; P = 0.01) and mixed venous oxygen saturation (SvO2) (36%; P < 0.0001) were observed compared with the control group. The interventricular septum deviated toward the left ventricle (LV). Milrinone improved RV-PRSW and CI and maintained systemic pressure while reducing central venous pressure (CVP). Epinephrine and dopamine further improved biventricular PRSW and CI equally in a dose-dependent manner. Systemic and pulmonary pressures were higher in the dopamine-treated animals compared with epinephrine-treated animals. None of the treatments improved stroke volume index (SVI) despite increases in contractility. Strong correlation was detected between SVI and LV-EDVI, but not SVI and biventricular contractility. In RVF due to PR, milrinone significantly improved CI, SvO2, and CVP and increased contractility in the RV. Epinephrine and dopamine had equal inotropic effect, but a greater vasopressor effect was observed for dopamine. SV was unchanged due to inability of both treatments to increase LV-EDVI.
authors.affiliation: Departments of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Janus Adler
authors.identifier: http://orcid.org/0000-0001-8318-0323
authors.initials: JA
authors.lastname: Hyldebrandt
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; and Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Agger
authors.affiliation: Departments of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark;
authors.forename: Eleonora
authors.initials: E
authors.lastname: Sivén
authors.affiliation: Departments of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark;
authors.forename: Kristian Borup
authors.initials: KB
authors.lastname: Wemmelund
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; and.
authors.forename: Johan
authors.initials: J
authors.lastname: Heiberg
authors.affiliation: Departments of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark;
authors.forename: Christian Alcaraz
authors.initials: CA
authors.lastname: Frederiksen
authors.affiliation: Departments 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; D004298:Dopamine / Q000494:pharmacology / Q000627:therapeutic use*; D004837:Epinephrine / Q000494:pharmacology / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006439:Hemodynamics / Q000187:drug effects*; D020105:Milrinone / Q000494:pharmacology / Q000627:therapeutic use*; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000188:drug therapy*; D013552:Swine; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone; D004298:Dopamine; D004837:Epinephrine
keywords: dopamine; epinephrine; heart failure; hemodynamics; milrinone; pulmonary valve regurgitation; right ventricular failure