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Effects of levosimendan versus dobutamine on pressure load-induced right ventricular failure.
Crit Care Med. 2006 Nov; 34(11):2814-9.CC

Abstract

OBJECTIVE

A transient increase in pulmonary arterial (PA) pressure can persistently depress right ventricular (RV) contractility. We investigated the effects of dobutamine and levosimendan on RV-PA coupling in this model of RV failure.

DESIGN

Prospective, controlled, randomized animal study.

SETTING

University research laboratory.

SUBJECTS

Fifteen anesthetized dogs.

INTERVENTIONS

Transient (90-min) PA constriction to induce persistent RV failure. Random assignment to dobutamine 5 and 10 microg/kg/min or levosimendan 12 microg/kg for 10 mins followed by 0.1 and 0.2 microg/kg/min.

MEASUREMENTS AND MAIN RESULTS

We measured PA distal resistance and proximal elastance by pressure-flow relationships and vascular impedance. We measured RV contractility by the end-systolic pressure-volume relationship (Ees), PA effective elastance by the end-diastolic to end-systolic relationship (Ea), and RV-PA coupling efficiency by the Ees/Ea ratio. PA constriction persistently increased PA resistance and elastance, increased Ea from 0.95 +/- 0.07 to 3.01 +/- 0.28 mm Hg/mL, decreased Ees from 1.17 +/- 0.09 to 0.58 +/- 0.07 mm Hg/mL, and decreased Ees/Ea from 1.26 +/- 0.09 to 0.22 +/- 0.03 (p < .05). Dobutamine did not affect pulmonary hemodynamics, markedly increased RV contractility, and improved RV-PA coupling. Levosimendan decreased PA resistance and elastance, increased RV contractility, and restored RV-PA coupling. Compared with dobutamine, levosimendan decreased RV afterload and therefore better restored RV-PA coupling at similar inotropic state.

CONCLUSIONS

A transient increase in PA pressure persistently worsens PA hemodynamics, RV contractility, RV-PA coupling, and cardiac output. Levosimendan restores RV-PA coupling better than dobutamine because of similar inotropic effects and additional pulmonary vasodilatory effects.

Authors+Show Affiliations

Laboratory of Physiology, Free University of Brussels, Brussels, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16971854

Citation

Kerbaul, François, et al. "Effects of Levosimendan Versus Dobutamine On Pressure Load-induced Right Ventricular Failure." Critical Care Medicine, vol. 34, no. 11, 2006, pp. 2814-9.
Kerbaul F, Rondelet B, Demester JP, et al. Effects of levosimendan versus dobutamine on pressure load-induced right ventricular failure. Crit Care Med. 2006;34(11):2814-9.
Kerbaul, F., Rondelet, B., Demester, J. P., Fesler, P., Huez, S., Naeije, R., & Brimioulle, S. (2006). Effects of levosimendan versus dobutamine on pressure load-induced right ventricular failure. Critical Care Medicine, 34(11), 2814-9.
Kerbaul F, et al. Effects of Levosimendan Versus Dobutamine On Pressure Load-induced Right Ventricular Failure. Crit Care Med. 2006;34(11):2814-9. PubMed PMID: 16971854.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of levosimendan versus dobutamine on pressure load-induced right ventricular failure. AU - Kerbaul,François, AU - Rondelet,Benoît, AU - Demester,Jean-Paul, AU - Fesler,Pierre, AU - Huez,Sandrine, AU - Naeije,Robert, AU - Brimioulle,Serge, PY - 2006/9/15/pubmed PY - 2006/12/9/medline PY - 2006/9/15/entrez SP - 2814 EP - 9 JF - Critical care medicine JO - Crit. Care Med. VL - 34 IS - 11 N2 - OBJECTIVE: A transient increase in pulmonary arterial (PA) pressure can persistently depress right ventricular (RV) contractility. We investigated the effects of dobutamine and levosimendan on RV-PA coupling in this model of RV failure. DESIGN: Prospective, controlled, randomized animal study. SETTING: University research laboratory. SUBJECTS: Fifteen anesthetized dogs. INTERVENTIONS: Transient (90-min) PA constriction to induce persistent RV failure. Random assignment to dobutamine 5 and 10 microg/kg/min or levosimendan 12 microg/kg for 10 mins followed by 0.1 and 0.2 microg/kg/min. MEASUREMENTS AND MAIN RESULTS: We measured PA distal resistance and proximal elastance by pressure-flow relationships and vascular impedance. We measured RV contractility by the end-systolic pressure-volume relationship (Ees), PA effective elastance by the end-diastolic to end-systolic relationship (Ea), and RV-PA coupling efficiency by the Ees/Ea ratio. PA constriction persistently increased PA resistance and elastance, increased Ea from 0.95 +/- 0.07 to 3.01 +/- 0.28 mm Hg/mL, decreased Ees from 1.17 +/- 0.09 to 0.58 +/- 0.07 mm Hg/mL, and decreased Ees/Ea from 1.26 +/- 0.09 to 0.22 +/- 0.03 (p < .05). Dobutamine did not affect pulmonary hemodynamics, markedly increased RV contractility, and improved RV-PA coupling. Levosimendan decreased PA resistance and elastance, increased RV contractility, and restored RV-PA coupling. Compared with dobutamine, levosimendan decreased RV afterload and therefore better restored RV-PA coupling at similar inotropic state. CONCLUSIONS: A transient increase in PA pressure persistently worsens PA hemodynamics, RV contractility, RV-PA coupling, and cardiac output. Levosimendan restores RV-PA coupling better than dobutamine because of similar inotropic effects and additional pulmonary vasodilatory effects. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/16971854/Effects_of_levosimendan_versus_dobutamine_on_pressure_load_induced_right_ventricular_failure_ L2 - https://dx.doi.org/10.1097/01.CCM.0000242157.19347.50 DB - PRIME DP - Unbound Medicine ER -