-
JACC. Case Reports Mar 2024Dobutamine is a positive inotropic agent often used in treatment of cardiogenic shock. Although there are well-documented adverse effects, dobutamine-induced myoclonus...
Dobutamine is a positive inotropic agent often used in treatment of cardiogenic shock. Although there are well-documented adverse effects, dobutamine-induced myoclonus is a rarely reported phenomenon. Our case offers a direct and temporally related description of myoclonus, with onset observed within hours of dobutamine initiation and complete resolution within minutes of discontinuation.
PubMed: 38549854
DOI: 10.1016/j.jaccas.2024.102255 -
Journal of Cardiovascular Pharmacology Mar 2024To synthesize the available evidence regarding differences in the long-term safety and efficacy of intermittent, repeated, or continuous palliative inotropic therapy...
Comparative effectiveness and safety of intermittent, repeated or continuous use of levosimendan, milrinone, or dobutamine in patients with advanced heart failure: a network and single-arm meta-analysis.
To synthesize the available evidence regarding differences in the long-term safety and efficacy of intermittent, repeated, or continuous palliative inotropic therapy among patients with advanced heart failure (HF). We systematically searched the PubMed, Embase, and Cochrane Library electronic databases, with a cutoff date of November 23, 2023, for studies reporting outcomes in adult patients with advanced HF treated with intermittent, repeated, or continuous levosimendan, milrinone, or dobutamine. Forty-one studies (18 randomized controlled trials and 23 cohort studies) comprising 5137 patients met the inclusion criteria. The results of the network meta-analysis of randomized controlled trials showed that levosimendan had significant advantages over milrinone or dobutamine in reducing mortality and improving LVEF. A single-arm meta-analysis also indicated that levosimendan had the lowest mortality and significantly improved BNP and LVEF. Regarding safety, hypotension events were observed more frequently in the levosimendan group and milrinone groups. However, the current evidence is limited by the heterogeneity and relatively small sample size of the studies.
PubMed: 38547524
DOI: 10.1097/FJC.0000000000001561 -
Cureus Feb 2024The aim of this systematic review and meta-analysis was to compare the outcomes between milrinone and dobutamine in patients with cardiogenic shock. The search strategy... (Review)
Review
The aim of this systematic review and meta-analysis was to compare the outcomes between milrinone and dobutamine in patients with cardiogenic shock. The search strategy involved a comprehensive exploration of electronic databases, including PubMed, EMBASE, Cochrane Library, and Scopus from the the inception of each database up to the 31st of January 2024. A combination of keywords and Medical Subject Headings (MeSH) terms was employed to identify relevant studies. The outcomes assessed in this meta-analysis included all-cause in-hospital mortality, length of intensive care unit (ICU stay), and length of hospital stay. A total of seven studies were included in this meta-analysis enrolling 3,841 patients (2,331 in the dobutamine group and 1,510 in the milrinone group). Pooled analysis showed that the risk of all-cause mortality was significantly higher in patients receiving dobutamine compared to patients receiving milrinone (relative risk (RR): 1.43, 95% confidence interval (CI): 1.02 to 2.01, p-value: 0.04). However, the length of hospital stay and length of ICU stay were not significantly different between the two groups. Limited data are available to favor the use of one inotropic agent over another. Dobutamine might lead to a shorter hospital length of stay, but there is also a risk of increased all-cause mortality. Larger randomized studies with adequate power are needed to validate these observations.
PubMed: 38544600
DOI: 10.7759/cureus.54948 -
Health Science Reports Mar 2024Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with...
BACKGROUND
Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with perioperative morbidity is intraoperative hypotension (IOH). The main aim of this pilot study is to determine if the intraoperative use of goal-directed hemodynamic therapy (GDHT) is associated with a reduction in the number of IOH events in this population.
METHODS
A before-and-after study design. The patients who had intraoperative GDHT were compared to patients from a previous period before the implementation of GDHT. The primary outcome was the number of IOH episodes defined as five or more successive minutes with a mean arterial pressure <65 mmHg. The secondary outcomes included major postoperative morbidity and 30-day mortality.
RESULTS
A total of 414 patients were included. These were divided into two groups. The control group ( = 346; January 1, 2018, to December 31, 2019), and the monitored group ( = 68; January 1, 2020, to May 1, 2021). The median intraoperative administered fluid volume was similar between the control and monitored groups (2250 interquartile range [IQR] [1607-3050] vs. 2210 IQR [1700-2807] mL). The monitored group was found to have an increased use of norepinephrine and dobutamine (respectively, 1.2% vs. 5.9% and 2.4% vs. 30.9%; < 0.05). When adjusting for confounders (comorbidities, estimated blood loss, and duration of anesthesia) the incidence rate ratio (95% confidence interval) of number of IOH events was 0.94 (0.86-1.03), = 0.24. The rate of postoperative flap and medical complications did not differ between the two groups.
CONCLUSIONS
Even though the use of vasopressors/inotropes was higher in the monitored group, the number of IOH episodes and postoperative morbidity and mortality were similar between the two groups. Further change in hemodynamic management will require the use of specific blood pressure targets in the GDHT fluid algorithm.
PubMed: 38524770
DOI: 10.1002/hsr2.1943 -
Frontiers in Pharmacology 2024We conducted a systematic review to assess the advantages and disadvantages of levosimendan in patients with sepsis compared with placebo, milrinone, and dobutamine and...
We conducted a systematic review to assess the advantages and disadvantages of levosimendan in patients with sepsis compared with placebo, milrinone, and dobutamine and to explore the clinical efficacy of different concentrations of levosimendan. PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang data, VIP, and CBM databases were searched using such keywords as simendan, levosimendan, and sepsis. The search time was from the establishment of the database to July 2023. Two researchers were responsible for literature screening and data collection respectively. After the risk of bias in the included studies was evaluated, network meta-analysis was performed using R software gemtc and rjags package. Thirty-two randomized controlled trials (RCTs) were included in the network meta-analysis. Meta-analysis results showed that while levosimendan significantly improved CI levels at either 0.1 µg/kg/min (mean difference [MD] [95%CrI] = 0.41 [-0.43, 1.4]) or 0.2 µg/kg/min (MD [95%CrI] =0.54 [0.12, 0.99]). Levosimendan, at either 0.075 µg/kg/min (MD [95% CrI] =0.033 [-0.75, 0.82]) or 0.2 µg/kg/min (MD [95% CrI] = -0.014 [-0.26, 0.23]), had no significant advantage in improving Lac levels. Levosimendan, at either 0.1 µg/kg/min (RR [95% CrI] = 0.99 [0.73, 1.3]) or 0.2 µg/kg/min (RR [95% CrI] = 1.0 [0.88, 1.2]), did not have a significant advantage in reducing mortality. The existing evidence suggests that levosimendan can significantly improve CI and lactate levels in patients with sepsis, and levosimendan at 0.1 µg/kg/min might be the optimal dose. Unfortunately, all interventions in this study failed to reduce the 28-day mortality. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441220.
PubMed: 38523635
DOI: 10.3389/fphar.2024.1358735 -
European Review For Medical and... Mar 2024OBJECTIVE: The primary aim of the present study was to determine the success of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in...
UNLABELLED
OBJECTIVE: The primary aim of the present study was to determine the success of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in detecting critical coronary artery disease (CAD) as identified by invasive coronary angiography (ICA), as well as to compare the positive predictive values (PPV) of different stress methods. Our secondary aim was to investigate demographic, laboratory, electrocardiographic, and echocardiographic variables that could predict true positive results. PATIENTS AND METHODS: The study was conducted with 317 consecutive patients. Exercise, dipyridamole, adenosine, or dobutamine were used as stress methods. According to the results of ICA, patients with and without critical CAD were divided into two groups and compared statistically. The independent predictors of true positive results of positive SPECT-MPI were determined using univariate and multivariate logistic regression analysis (MLRA). RESULTS: Among the patients, 129 (40.7%) were found to have critical CAD (+) and 188 (50.3%) critical CAD (-). The PPVs of different stress methods were similar. Age, diabetes, and monocyte to HDL ratio (MHR) were found to be independent predictors of critical CAD in MLRA (p<0.005, p=0.002, and p<0.005, respectively). ROC curve analysis revealed 81.4% sensitivity and 47.3% specificity (AUC: 0.683) at a cut-off of 57 for age and 72.1% sensitivity and 54.3% specificity (AUC: 0.649) for MHR at a cut-off of 9.7. CONCLUSIONS: The true positivity rate of SPECT-MPI is low. Moreover, this rate is much lower for women. The PPVs of different stress methods are similar. Age, presence of diabetes, and MHR ratio are independent predictors for true positive results of SPECT-MPI.
GRAPHICAL ABSTRACT
https://www.europeanreview.org/wp/wp-content/uploads/Graphical-abstract-9.jpg.
Topics: Humans; Female; Aged; Myocardial Perfusion Imaging; Adenosine; Coronary Artery Disease; Dobutamine; Diabetes Mellitus
PubMed: 38497864
DOI: 10.26355/eurrev_202403_35595 -
Physiological Reports Mar 2024Patients undergoing cardiopulmonary bypass procedures require inotropic support to improve hemodynamic function and cardiac output. Current inotropes such as dobutamine,...
Patients undergoing cardiopulmonary bypass procedures require inotropic support to improve hemodynamic function and cardiac output. Current inotropes such as dobutamine, can promote arrhythmias, prompting a demand for improved inotropes with little effect on intracellular Ca flux. Low-dose carbon monoxide (CO) induces inotropic effects in perfused hearts. Using the CO-releasing pro-drug, oCOm-21, we investigated if this inotropic effect results from an increase in myofilament Ca sensitivity. Male Sprague Dawley rat left ventricular cardiomyocytes were permeabilized, and myofilament force was measured as a function of -log [Ca ] (pCa) in the range of 9.0-4.5 under five conditions: vehicle, oCOm-21, the oCOm-21 control BP-21, and levosimendan, (9 cells/group). Ca sensitivity was assessed by the Ca concentration at which 50% of maximal force is produced (pCa ). oCOm-21, but not BP-21 significantly increased pCa compared to vehicle, respectively (pCa 5.52 vs. 5.47 vs. 5.44; p < 0.05). No change in myofilament phosphorylation was seen after oCOm-21 treatment. Pretreatment of cardiomyocytes with the heme scavenger hemopexin, abolished the Ca sensitizing effect of oCOm-21. These results support the hypothesis that oCOm-21-derived CO increases myofilament Ca sensitivity through a heme-dependent mechanism but not by phosphorylation. Further analyses will confirm if this Ca sensitizing effect occurs in an intact heart.
Topics: Rats; Animals; Humans; Male; Myofibrils; Carbon Monoxide; Myocardial Contraction; Rats, Sprague-Dawley; Myocytes, Cardiac; Heme; Calcium
PubMed: 38491822
DOI: 10.14814/phy2.15974 -
American Journal of Physiology. Heart... May 2024Noncritical aortic coarctation (COA) typically presents beyond early childhood with hypertension. Correction of COA does not ensure a return to normal cardiovascular...
Noncritical aortic coarctation (COA) typically presents beyond early childhood with hypertension. Correction of COA does not ensure a return to normal cardiovascular health, but the mechanisms are poorly understood. Therefore, we developed a porcine COA model to study the secondary cardiovascular changes. Eight male neonatal piglets (4 sham, 4 COA) underwent left posterolateral thoracotomy with descending aorta (DAO) mobilization. COA was created via a 1-cm longitudinal DAO incision with suture closure, plication, and placement and an 8-mm external band. All animals had cardiac catheterization at 6 (11-13 kg), 12 (26-31 kg), and 20 (67-70 kg) wk of age. Aortic luminal diameters were similar along the thoracic aorta, except for the COA region [6.4 mm COA vs. 17.3 mm sham at 20 wk ( < 0.001)]. Collateral flow could be seen as early as 6 wk. COA peak systolic pressure gradient was 20 mmHg at 6 wk and persisted through 20 wk increasing to 40 mmHg with dobutamine. Pulse pressures distal to the COA were diminished at 12 and 20 wk. This model addresses many limitations of prior COA models including neonatal creation at an expected anatomic position with intimal injury and vessel sizes similar to humans. A neonatal model of aortic coarctation was developed in a porcine model using a readily reproducible method of aortic plication and external wrap placement. This model addresses the limitations of existing models including neonatal stenosis creation, appropriate anatomic location of the stenosis, and intimal injury creation and mimics human somatic growth. Pigs met American Heart Association (AHA) criteria for consideration of intervention, and the stenoses were graded as moderate to severe.
Topics: Humans; Child, Preschool; Infant, Newborn; Male; Animals; Swine; Aortic Coarctation; Constriction, Pathologic; Aorta, Thoracic; Aorta; Hypertension
PubMed: 38488518
DOI: 10.1152/ajpheart.00087.2024 -
European Heart Journal May 2024The ecto-nucleoside triphosphate diphosphohydrolases of the CD39 family degrade ATP and ADP into AMP, which is converted into adenosine by the extracellular...
BACKGROUND AND AIMS
The ecto-nucleoside triphosphate diphosphohydrolases of the CD39 family degrade ATP and ADP into AMP, which is converted into adenosine by the extracellular CD73/ecto-5-nucleotidase. This pathway has been explored in antithrombotic treatments but little in myocardial protection. We have investigated whether the administration of solCD39L3 (AZD3366) confers additional cardioprotection to that of ticagrelor alone in a pre-clinical model of myocardial infarction (MI).
METHODS
Ticagrelor-treated pigs underwent balloon-induced MI (90 min) and, before reperfusion, received intravenously either vehicle, 1 mg/kg AZD3366 or 3 mg/kg AZD3366. All animals received ticagrelor twice daily for 42 days. A non-treated MI group was run as a control. Serial cardiac magnetic resonance (baseline, Day 3 and Day 42 post-MI), light transmittance aggregometry, bleeding time, and histological and molecular analyses were performed.
RESULTS
Ticagrelor reduced oedema formation and infarct size at Day 3 post-MI vs. controls. A 3 mg/kg AZD3366 provided an additional 45% reduction in oedema and infarct size compared with ticagrelor and a 70% reduction vs. controls (P < .05). At Day 42, infarct size declined in all ticagrelor-administered pigs, particularly in 3 mg/kg AZD3366-treated pigs (P < .05). Left ventricular ejection fraction was diminished at Day 3 in placebo pigs and worsened at Day 42, whereas it remained unaltered in ticagrelor ± AZD3366-administered animals. Pigs administered with 3 mg/kg AZD3366 displayed higher left ventricular ejection fraction upon dobutamine stress at Day 3 and minimal dysfunctional segmental contraction at Day 42 (χ2P < .05 vs. all). Cardiac and systemic molecular readouts supported these benefits. Interestingly, AZD3366 abolished ADP-induced light transmittance aggregometry without affecting bleeding time.
CONCLUSIONS
Infusion of AZD3366 on top of ticagrelor leads to enhanced cardioprotection compared with ticagrelor alone.
Topics: Animals; Humans; Male; Adenosine; Antigens, CD; Apyrase; Cardiotonic Agents; Disease Models, Animal; Myocardial Infarction; Platelet Aggregation; Recombinant Proteins; Swine; Ticagrelor; Adenosine Triphosphatases
PubMed: 38486376
DOI: 10.1093/eurheartj/ehae107 -
Inhalation Toxicology Mar 2024Inhalation of diesel exhaust (DE) has been shown to be an occupational hazard in the transportation, mining, and gas and oil industries. DE also contributes to air...
OBJECTIVE
Inhalation of diesel exhaust (DE) has been shown to be an occupational hazard in the transportation, mining, and gas and oil industries. DE also contributes to air pollution, and therefore, is a health hazard to the general public. Because of its effects on human health, changes have been made to diesel engines to reduce both the amounts of particulate matter and volatile fumes they generate. The goal of the current study was to examine the effects of inhalation of diesel exhaust.
MATERIALS AND METHODS
The study presented here specifically examines the effects of exposure to 0.2 and 1.0 mg/m DE or filtered air (6h/d for 4 d) on measures of peripheral and cardio-vascular function, and biomarkers of heart and kidney dysfunction in male rats. A Tier 2 engine used in oil and gas fracking operations was used to generate the diesel exhaust.
RESULTS
Exposure to 0.2 mg/m DE resulted in an increase in blood pressure 1d following the last exposure, and increases in dobutamine-induced cardiac output and stroke volume 1 and 27d after exposure. Changes in peripheral vascular responses to norepinephrine and acetylcholine were minimal as were changes in transcript expression in the heart and kidney. Exposure to 1.0 mg/m DE did not result in major changes in blood pressure, measures of cardiac function, peripheral vascular function or transcript expression.
DISCUSSION AND CONCLUSIONS
Based on the results of this study, we suggest that exposure to DE generated by a Tier 2 compliant diesel engine generates acute effects on biomarkers indicative of cardiovascular dysfunction. Recovery occurs quickly with most measures of vascular/cardiovascular function returning to baseline levels by 7d following exposure.
Topics: Humans; Male; Rats; Animals; Air Pollutants; Vehicle Emissions; Particulate Matter; Air Pollution; Biomarkers; Inhalation Exposure
PubMed: 38466202
DOI: 10.1080/08958378.2024.2327364