TY - JOUR
T1 - Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction
AU - Dell'Italia, L. J.
AU - Starling, M. R.
AU - Blumhardt, R.
AU - Lasher, J. C.
AU - O'Rourke, R. A.
PY - 1985
Y1 - 1985
N2 - To assess the value of volume loading and to determine the relative efficacy of dobutamine compared with nitroprusside therapy in acute right ventricular infarction (RVMI), 13 patients with clinical, hemodynamic, and radionuclide angiographic evidence of RVMI were evaluated. In 10 patients who had an initial pulmonary arterial wedge pressure less than 18 mm Hg, volume loading did not improve cardiac index (1.9 ± 0.5 [SD] to 2.1 ± 0.4 liters/min/m2), despite significant increases in mean right atrial pressure (11 ± 2 to 15 ± 2 mm Hg, p < .001) and pulmonary arterial wedge pressure (10 ± 4 to 15 ± 2 mm Hg, p < .001). Nine patients received dobutamine or nitroprusside in random order, while hemodynamic measurements and radionuclide angiograms were obtained simultaneously. Compared with nitroprusside, dobutamine produced a statistically significant increase in cardiac index (2.0 ± 0.4 to 2.7 ± 0.5 vs 2.1 ± 0.4 to 2.3 ±0.5 liters/min/m2, p < .001), stroke volume index (29 ± 6 to 36 ± 8 vs 29 ± 6 to 30 ± 6 ml/m2, p = .02), and right ventricular ejection fraction (30 ± 8% to 42 ± 7% vs 34 ± 8% to 37 ± 4%, p < .01) by two-way analysis of variance. We conclude that volume loading does not improve cardiac index in patients with acute RVMI despite a rise in cardiac filling pressures and that infusion of dobutamine, after appropriate volume loading, produces a significant improvement in cardiac index and right ventricular ejection fraction over those after infusion of nitroprusside.
AB - To assess the value of volume loading and to determine the relative efficacy of dobutamine compared with nitroprusside therapy in acute right ventricular infarction (RVMI), 13 patients with clinical, hemodynamic, and radionuclide angiographic evidence of RVMI were evaluated. In 10 patients who had an initial pulmonary arterial wedge pressure less than 18 mm Hg, volume loading did not improve cardiac index (1.9 ± 0.5 [SD] to 2.1 ± 0.4 liters/min/m2), despite significant increases in mean right atrial pressure (11 ± 2 to 15 ± 2 mm Hg, p < .001) and pulmonary arterial wedge pressure (10 ± 4 to 15 ± 2 mm Hg, p < .001). Nine patients received dobutamine or nitroprusside in random order, while hemodynamic measurements and radionuclide angiograms were obtained simultaneously. Compared with nitroprusside, dobutamine produced a statistically significant increase in cardiac index (2.0 ± 0.4 to 2.7 ± 0.5 vs 2.1 ± 0.4 to 2.3 ±0.5 liters/min/m2, p < .001), stroke volume index (29 ± 6 to 36 ± 8 vs 29 ± 6 to 30 ± 6 ml/m2, p = .02), and right ventricular ejection fraction (30 ± 8% to 42 ± 7% vs 34 ± 8% to 37 ± 4%, p < .01) by two-way analysis of variance. We conclude that volume loading does not improve cardiac index in patients with acute RVMI despite a rise in cardiac filling pressures and that infusion of dobutamine, after appropriate volume loading, produces a significant improvement in cardiac index and right ventricular ejection fraction over those after infusion of nitroprusside.
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U2 - 10.1161/01.CIR.72.6.1327
DO - 10.1161/01.CIR.72.6.1327
M3 - Article
C2 - 4064277
AN - SCOPUS:0022337853
VL - 72
SP - 1327
EP - 1335
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 6
ER -