title: Early treatment with isoflurane attenuates left ventricular dysfunction and improves survival in experimental Takotsubo.
abstract: BACKGROUND
  Takotsubo syndrome (TS) is an acute cardiac condition, often triggered by critical illness, for which no specific treatment exists. Previously, we showed that isoflurane can prevent experimental TS. The aim of this study was to evaluate the potential treatment effects of isoflurane. Our primary hypothesis was that early treatment with isoflurane attenuates left ventricular akinesia in experimental TS.
  
  
  METHODS
  In propofol-sedated animals, TS was induced by an intraperitoneal bolus of isoprenaline (50 mg/kg). Animals were randomized to one of six groups (n = 15 in each group), and 1% isoflurane was administered for 90 min in all groups. Isoflurane treatment was started at 0, 10, 30 (early treatment) or 120 (late treatment) minutes after isoprenaline injection. One additional late treatment group received isoflurane 0.5% for 180 min. A control group did not receive isoflurane. Left ventricular (LV) echocardiographic examination was performed at 90 min and 48 h after isoprenaline. Mortality was assessed at 48 h.
  
  
  RESULTS
  Median degree of LV akinesia at 90 min was 24% in the control group and 0% in the early treatment groups (P < 0.001). Stroke volume, cardiac output and LV ejection fraction were higher in the early treatment groups vs. controls (P < 0.01). Mortality was lower in the early treatment groups (24%) vs. controls (86%) (P < 0.001). Mortality did not differ between the late treatment groups and controls.
  
  
  CONCLUSIONS
  Early treatment with isoflurane attenuates the LV akinesia and improves survival in experimental TS. Isoflurane sedation in patients at risk of developing Takotsubo syndrome could be a subject for future studies.
authors.affiliation: The Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Oras
authors.affiliation: Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Ali
authors.affiliation: Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Alkhoury
authors.affiliation: The Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Seeman-Lodding
authors.affiliation: Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Omerovic
authors.affiliation: The Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: S-E
authors.initials: SE
authors.lastname: Ricksten
mesh_terms: D000318:Adrenergic beta-Agonists; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D000818:Animals; D002302:Cardiac Output / Q000187:drug effects; D004452:Echocardiography; D007530:Isoflurane / Q000627:therapeutic use*; D007545:Isoproterenol; D053208:Kaplan-Meier Estimate; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D013318:Stroke Volume / Q000187:drug effects; D016019:Survival Analysis; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000318:Adrenergic beta-Agonists; D018685:Anesthetics, Inhalation; D007530:Isoflurane; D007545:Isoproterenol