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Dayer N, Ltaief Z, Liaudet L, Lechartier B, Aubert JD, Yerly P. Pressure Overload and Right Ventricular Failure: From Pathophysiology to Treatment. J Clin Med 2023; 12:4722. [PMID: 37510837 PMCID: PMC10380537 DOI: 10.3390/jcm12144722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/01/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Right ventricular failure (RVF) is often caused by increased afterload and disrupted coupling between the right ventricle (RV) and the pulmonary arteries (PAs). After a phase of adaptive hypertrophy, pressure-overloaded RVs evolve towards maladaptive hypertrophy and finally ventricular dilatation, with reduced stroke volume and systemic congestion. In this article, we review the concept of RV-PA coupling, which depicts the interaction between RV contractility and afterload, as well as the invasive and non-invasive techniques for its assessment. The current principles of RVF management based on pathophysiology and underlying etiology are subsequently discussed. Treatment strategies remain a challenge and range from fluid management and afterload reduction in moderate RVF to vasopressor therapy, inotropic support and, occasionally, mechanical circulatory support in severe RVF.
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Affiliation(s)
- Nicolas Dayer
- Department of Cardiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland;
| | - Zied Ltaief
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (Z.L.); (L.L.)
| | - Lucas Liaudet
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (Z.L.); (L.L.)
| | - Benoit Lechartier
- Department of Respiratory Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (B.L.); (J.-D.A.)
| | - John-David Aubert
- Department of Respiratory Medicine, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (B.L.); (J.-D.A.)
| | - Patrick Yerly
- Department of Cardiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland;
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An evidence-based review of the use of vasoactive and inotropic medications in post-operative paediatric patients after cardiac surgery with cardiopulmonary bypass from 2000 to 2020. Cardiol Young 2020; 30:1757-1771. [PMID: 33213604 DOI: 10.1017/s1047951120004151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infants with moderate-to-severe CHD frequently undergo cardiopulmonary bypass surgery in childhood. Morbidity and mortality are highest in those who develop post-operative low cardiac output syndrome. Vasoactive and inotropic medications are mainstays of treatment for these children, despite limited evidence supporting their use. METHODS To help inform clinical practice, as well as the conduct of future trials, we performed a systematic review of existing literature on inotropes and vasoactives in children after cardiac surgery using the PubMed and EMBASE databases. We included studies from 2000 to 2020, and the patient population was defined as birth - 18 years of age. Two reviewers independently reviewed studies to determine final eligibility. RESULTS The final analysis included 37 papers. Collectively, selected studies reported on 12 different vasoactive and inotropic medications in 2856 children. Overall evidence supporting the use of these drugs in children after cardiopulmonary bypass was limited. The majority of studies were small with 30/37 (81%) enrolling less than 100 patients, 29/37 (78%) were not randomised, and safety and efficacy endpoints differed widely, limiting the ability to combine data for meta-analyses. CONCLUSION Vasoactive and inotropic support remain critical parts of post-operative care for children after cardiopulmonary bypass surgery. There is a paucity of data for the selection and dosing of vasoactives and inotropes for these patients. Despite the knowledge gaps that remain, numerous recent innovations create opportunities to rethink the conduct of clinical trials in this high-risk population.
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Benjamin MM, Sundararajan S, Sulaiman S, Miles B, Walker RJ, Durham L, Kohmoto T, Joyce DL, Ishizawar D, Gaglianello N, Mohammed A. Association of preoperative duration of inotropy on prevalence of right ventricular failure following LVAD implantation. ESC Heart Fail 2020; 7:1949-1955. [PMID: 32526807 PMCID: PMC7373884 DOI: 10.1002/ehf2.12791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022] Open
Abstract
Aims 20% to 40% of left ventricular assist device (LVAD) device implantations are complicated by right ventricular (RV) failure that results in significant morbidity and mortality. We hypothesized that the duration on milrinone infusion is an independent risk factor for RV failure following LVAD implantation. Methods and results Retrospective demographic, clinical and hemodynamic data were collected on all adults with ACC/AHA stage D heart failure on intravenous milrinone who underwent LVAD implantation between 2012 and 2019. Patients (n = 104) were divided into two groups, those on milrinone <30 days (STM, n = 55) vs. ≥30 (LTM, n = 49). The primary endpoint was the prevalence of RV failure (need for inotropic support for more than 14 days or RV assist device) within 30 days post‐LVAD implantation. There were no significant differences between STM and LTM patients with respect to demographic, echocardiographic, right heart catheterization data, or baseline medications. The mean age of patients was 55.6 ± 12 years (70% male patients). Mean duration on milrinone was 13.7 vs. 81.0 days in STM and LTM, respectively. Forty‐five (43.3%) patients developed RV failure. LTM had higher prevalence of RV failure with odds ratio (OR) = 5.04 (95% CI 2.18–11.68, P = 0.0002). After adjusting for age, gender, and co‐morbidity count, the OR was 6.33 (95% CI 2.51–15.93), P < 0.0001. Conclusions In this retrospective study of ACC/AHA stage D HF patients, longer duration of milrinone infusion was associated with higher prevalence of RV failure after LVAD implantation.
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Affiliation(s)
- Mina M Benjamin
- Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Sakthi Sundararajan
- Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Samian Sulaiman
- Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Bryan Miles
- Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Lucian Durham
- Division of Cardiothoracic Surgery, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Takushi Kohmoto
- Division of Cardiothoracic Surgery, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - David L Joyce
- Division of Cardiothoracic Surgery, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - David Ishizawar
- Division of Cardiovascular Medicine, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Nunzio Gaglianello
- Division of Cardiovascular Medicine, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Asim Mohammed
- Division of Cardiovascular Medicine, Froedtert & The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
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Sucharov CC, Nakano SJ, Slavov D, Schwisow JA, Rodriguez E, Nunley K, Medway A, Stafford N, Nelson P, McKinsey TA, Movsesian M, Minobe W, Carroll IA, Taylor MRG, Bristow MR. A PDE3A Promoter Polymorphism Regulates cAMP-Induced Transcriptional Activity in Failing Human Myocardium. J Am Coll Cardiol 2020; 73:1173-1184. [PMID: 30871701 DOI: 10.1016/j.jacc.2018.12.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/20/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The phosphodiesterase 3A (PDE3A) gene encodes a PDE that regulates cardiac myocyte cyclic adenosine monophosphate (cAMP) levels and myocardial contractile function. PDE3 inhibitors (PDE3i) are used for short-term treatment of refractory heart failure (HF), but do not produce uniform long-term benefit. OBJECTIVES The authors tested the hypothesis that drug target genetic variation could explain clinical response heterogeneity to PDE3i in HF. METHODS PDE3A promoter studies were performed in a cloned luciferase construct. In human left ventricular (LV) preparations, mRNA expression was measured by reverse transcription polymerase chain reaction, and PDE3 enzyme activity by cAMP-hydrolysis. RESULTS The authors identified a 29-nucleotide (nt) insertion (INS)/deletion (DEL) polymorphism in the human PDE3A gene promoter beginning 2,214 nt upstream from the PDE3A1 translation start site. Transcription factor ATF3 binds to the INS and represses cAMP-dependent promoter activity. In explanted failing LVs that were homozygous for PDE3A DEL and had been treated with PDE3i pre-cardiac transplantation, PDE3A1 mRNA abundance and microsomal PDE3 enzyme activity were increased by 1.7-fold to 1.8-fold (p < 0.05) compared with DEL homozygotes not receiving PDE3i. The basis for the selective up-regulation in PDE3A gene expression in DEL homozygotes treated with PDE3i was a cAMP response element enhancer 61 nt downstream from the INS, which was repressed by INS. The DEL homozygous genotype frequency was also enriched in patients with HF. CONCLUSIONS A 29-nt INS/DEL polymorphism in the PDE3A promoter regulates cAMP-induced PDE3A gene expression in patients treated with PDE3i. This molecular mechanism may explain response heterogeneity to this drug class, and may inform a pharmacogenetic strategy for a more effective use of PDE3i in HF.
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Affiliation(s)
- Carmen C Sucharov
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado.
| | - Stephanie J Nakano
- Department of Pediatrics, University of Colorado Denver, Children's Hospital Colorado, Aurora, Colorado
| | - Dobromir Slavov
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Jessica A Schwisow
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Erin Rodriguez
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Karin Nunley
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Allen Medway
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Natalie Stafford
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Penny Nelson
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Timothy A McKinsey
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado; University of Colorado Anschutz Medical Campus Consortium for Fibrosis Research & Translation, Aurora, Colorado
| | - Matthew Movsesian
- Cardiology Section, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Internal Medicine (Cardiovascular Medicine), University of Utah School of Medicine, Salt Lake City, Utah; Department of Pharmacology & Toxicology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Wayne Minobe
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | | | - Matthew R G Taylor
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado
| | - Michael R Bristow
- Division of Cardiology and Cardiovascular Institute, University of Colorado Denver, Aurora, Colorado; ARCA Biopharma, Westminster, Colorado
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Wang J, Zhu J, Zhong J, Sun J, Tang S, Guo C. Novel 4-Aryl-2-amino-6-(naphthalene-1-yl)-3-cyanopyridine Derivates as Potential Organic Fluorescent Materials Prepared Under Microwave Irradiation via Three-Component Domino Reactions. SYNTHETIC COMMUN 2014. [DOI: 10.1080/00397911.2014.891239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jianqiang Wang
- a College of Sciences , Nanjing Tech University , Jiangsu , Nanjing , China
| | - Jianlin Zhu
- a College of Sciences , Nanjing Tech University , Jiangsu , Nanjing , China
| | - Jie Zhong
- a College of Sciences , Nanjing Tech University , Jiangsu , Nanjing , China
| | - Jun Sun
- a College of Sciences , Nanjing Tech University , Jiangsu , Nanjing , China
| | - Shigui Tang
- b Biotechnology and Pharmaceutical Engineering , Nanjing Tech University , Jiangsu , Nanjing , China
| | - Cheng Guo
- a College of Sciences , Nanjing Tech University , Jiangsu , Nanjing , China
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Price LC, Wort SJ, Finney SJ, Marino PS, Brett SJ. Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Crit Care 2010; 14:R169. [PMID: 20858239 PMCID: PMC3219266 DOI: 10.1186/cc9264] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 05/30/2010] [Accepted: 09/21/2010] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Pulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care. METHODS A systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method. RESULTS Clinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy. CONCLUSIONS This systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.
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Affiliation(s)
- Laura C Price
- Department of Critical Care, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Stephen J Wort
- Department of Critical Care, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Simon J Finney
- Department of Critical Care, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Philip S Marino
- Department of Critical Care, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Stephen J Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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Zheng J, Ma J, Zhang P, Hu L, Fan X, Tang Q. Milrinone inhibits hypoxia or hydrogen dioxide-induced persistent sodium current in ventricular myocytes. Eur J Pharmacol 2009; 616:206-12. [PMID: 19549513 DOI: 10.1016/j.ejphar.2009.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 05/28/2009] [Accepted: 06/09/2009] [Indexed: 12/19/2022]
Abstract
Much evidence indicates that increased persistent sodium current (I(Na.P)) is associated with cellular calcium overload and I(Na.P) is considered to be a potential target for therapeutic intervention in ischaemia and heart failure. By inhibiting type III phosphodiesterase, milrinone increases intracellular cyclic adenosine monophosphate (cAMP), with a positive inotropic effect. However, the effect of milrinone on increased I(Na.P) under pathological conditions remains unknown. Accordingly, we investigated the effect of milrinone on increased I(Na.P) induced by hypoxia or hydrogen dioxide in guinea pig ventricular myocytes. While milrinone (0.01 mM or 0.1mM) or cAMP (0.1 mM) decreased I(Na.P) respectively in control condition, application of 1 microM H-89, a selective cAMP-dependant protein kinase inhibitor, prevented the effect of 0.1mM milrinone in control condition. Milrinone (0.1 mM) reduced the increased I(Na.P) induced by hypoxia. Furthermore, 0.01 mM or 0.1mM milrinone reduced the enhanced I(Na.P) induced by 0.3 mM hydrogen peroxide. In addition, 0.01 mM or 0.1 mM milrinone shortened action potential duration at 90% repolarization (APD(90)). Bath application of 0.3 mM hydrogen dioxide markedly prolonged APD(90), while 2 microM tetrodotoxin (TTX) reversed the prolonged APD(90). In the other two groups, 0.01 mM or 0.1 mM milrinone shortened the prolonged APD(90) induced by 0.3 mM hydrogen peroxide, ultimately 2 microM TTX causing a further decurtation of APD(90). These findings demonstrate that milrinone inhibited I(Na.P) under normal condition, hypoxia or hydrogen dioxide-induced I(Na.P), and the APD(90) prolonged by hydrogen dioxide-induced I(Na.P) in ventricular myocytes, which is associated with the mechanism of milrinone increasing intracellular cAMP.
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Affiliation(s)
- Jie Zheng
- Cardio-Electrophysiological Research Laboratory, Medical College, Wuhan University of Science and Technology, Wuhan, Hubei, China
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Boettger R, Lee J, Rifkin C, Kayser SR. Heart transplantation and altered drug response, Part II: pharmacologic management of post-transplantation complications. PROGRESS IN CARDIOVASCULAR NURSING 2006; 21:219-22. [PMID: 17170599 DOI: 10.1111/j.0889-7204.2006.04985.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Rebecca Boettger
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, CA 94143-0622, USA
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Fortenberry JD, Huber AR, Owens ML. Inotropes inhibit endothelial cell surface adhesion molecules induced by interleukin-1beta. Crit Care Med 1997; 25:303-8. [PMID: 9034269 DOI: 10.1097/00003246-199702000-00019] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Leukocyte-endothelial cell interactions play a critical role in sepsis-induced multiple organ system failure and acute respiratory distress syndrome. Increased cyclic adenosine 3',5'-monophosphate (cAMP) has been previously reported to inhibit expression of the cytokine-stimulated endothelial cell adhesion molecules, E-selectin, and vascular cell adhesion molecule-1 (VCAM-1). We hypothesized that clinically relevant concentrations of inotropes, such as amrinone and dopamine, which increase cAMP, could inhibit cytokine-stimulated upregulation of endothelial adhesion proteins. DESIGN Prospective, controlled in vitro study. SETTING Leukocyte biology laboratory. SUBJECTS Human umbilical vein endothelial cells isolated from neonatal umbilical cord specimens and whole blood obtained from normal human adult volunteers were used in this study. INTERVENTIONS Endothelial cell monolayers were pretreated with increasing concentrations of amrinone or dopamine, or left untreated as controls, followed by exposure to recombinant human interleukin (IL)-1beta for 6 hrs. Monolayers were then incubated with monoclonal antibodies to E-selectin, VCAM-1, and intercellular adhesion molecule-1 (ICAM-1), fluorescence labeled, and assessed for mean fluorescence intensity by flow cytometry as a measure of surface adhesion molecule concentrations. Whole blood neutrophils were pretreated with or without inotropes, then stimulated with n-formyl methyl leucine phenylalanine. Stimulated neutrophils were incubated with antibodies against the neutrophil adherence protein CD11b and assessed by flow cytometry. MEASUREMENTS AND MAIN RESULTS IL-1beta markedly increased E-selectin (p = .01), VCAM-1 (p < .01), and ICAM-1 (p < .001) concentrations (n = 6). Pretreatment with amrinone significantly decreased endothelial E-selectin surface values at all concentrations (p < .001 by analysis of variance, n = 5), including therapeutic concentration ranges. Amrinone also inhibited upregulation of ICAM-1 (p < .001) at therapeutic concentrations, and VCAM-1 (p < .001) at higher concentrations. Dopamine inhibited only E-selectin at relevant concentrations. Neutrophil pretreatment with inotropes did not prevent CD11b upregulation. CONCLUSIONS Pretreatment with amrinone, and to a lesser degree, with dopamine, at clinically relevant concentrations inhibits in vitro IL-1alpha-induced increases in human umbilical vein endothelial cell adhesion molecule concentrations. Future studies are necessary to investigate the mechanisms of these effects and to determine in vivo efficacy of inotropes as anti-inflammatory agents.
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Affiliation(s)
- J D Fortenberry
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Canepari M, Polla B, Gualea MR, Zanardi C, Reggiani C. Age-dependent reduction of the response of rat cardiac muscle to the phosphodiesterase inhibitor milrinone. ARCHIVES INTERNATIONALES DE PHYSIOLOGIE, DE BIOCHIMIE ET DE BIOPHYSIQUE 1994; 102:265-9. [PMID: 7849274 DOI: 10.3109/13813459409003942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study aimed to investigate whether milrinone effect on cardiac muscle contractility undergoes to age-related changes. Experiments were carried out on papillary muscles isolated from right ventricle of Brown Norway rats belonging to two different age groups: 2 month old and 18 month old. The effect of milrinone (10-100 microM) on rat cardiac muscle in vitro preparations was characterized by a reduction of peak developed tension and of contraction duration. Furthermore, the recovery of contractility after a contractile cycle, i.e. the mechanical restitution was faster in the presence of milrinone than in control conditions. All these effects were reduced in preparations from 18 month old rats compared to preparations from 2 month old rats. The decrease of milrinone effect on the mechanical restitution was particularly pronounced. The reduction of the milrinone effects is likely connected with the reduction of the maximal effect of adrenergic stimulation, although the molecular basis of this link is not yet clearly understood.
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Affiliation(s)
- M Canepari
- Institute of Human Physiology, University of Pavia, Italy
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Abstract
Heart failure is now viewed as a disorder of the circulation, not merely the heart, which becomes manifest only when certain compensatory mechanisms break down. After treatment with diuretics, the two main strategies in treating heart failure involve decreasing the work of the heart by vasodilatation or increasing ventricular contractility by positive inotropic agents. It is now apparent, however, that the resulting hemodynamic benefit need not equate with long-term clinical improvement or increased longevity; indeed, the reverse can be true. Inhibitors of phosphodiesterase III, which is specific for the breakdown of cyclic adenosine monophosphate (cAMP), produce useful hemodynamic effects following intravenous and oral dosing, but have not fulfilled their initial promise in the chronic oral treatment of heart failure patients. The reason for reduced survival in the long-term studies of milrinone is not clear, but cardiac arrhythmias, possibly resulting from the increased intracellular levels of cAMP, may be responsible. However, intravenous usage may not suffer from the same limitations as chronic oral dosing. Short-term intravenous administration produces the expected beneficial hemodynamic effects of positive inotropism and vasodilatation. Though infusions of milrinone have been shown to enhance atrioventricular conduction in some, but not all, studies, there appears to be no significant increase in ventricular premature contractions, or ventricular or sustained tachyarrhythmias. Because milrinone does not have a significant adverse effect on His-Purkinje conduction, its use should be well tolerated in patients with intraventricular conduction disturbances. However, accurate assessment of the mortality risk and benefit of short-term intravenous treatment remains to be made in sufficiently powerful prospective, randomized controlled studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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Diastolic Dysfunction of the Heart. Pharmacological Strategies for Modulating Calcium Sequestration of the Sarcoplasmic Reticulum. ACTA ACUST UNITED AC 1993. [DOI: 10.1007/978-1-4615-3090-9_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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13
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Skoyles JR, Sherry KM, Price C. Intravenous milrinone in patients with severe congestive cardiac failure awaiting heart transplantation. J Cardiothorac Vasc Anesth 1992; 6:222-5. [PMID: 1568013 DOI: 10.1016/1053-0770(92)90205-l] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J R Skoyles
- Department of Anaesthesia, Northern General Hospital, Sheffield, UK
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14
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Ross-Ascuitto NT, Ascuitto RJ, Ramage D, McDonough KH. The effects of milrinone in the neonatal pig heart. Cardiovasc Drugs Ther 1991; 5:1011-9. [PMID: 1724909 DOI: 10.1007/bf00143529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Milrinone, a selective inhibitor of phosphodiesterase (PDE), was examined in neonatal hearts and in ventricular myocytes. Isolated, paced (180 beats/min), isovolumically beating hearts from pigs, less than 3 days of age, were perfused with an erythrocyte-enriched solution. In one group (control, n = 6), milrinone was studied at perfusate concentrations of 1, 10, and 100 micrograms/ml. In a second group (postischemia, n = 10), hearts were subjected to 30 minutes of no-flow ischemic arrest, prior to the addition of milrinone. Left ventricular peak systolic pressure (PSP) and end-diastolic pressure, coronary flow (CF), heart rate (HR), and myocardial oxygen consumption (MVO2) were measured. The PSP averaged approximately 100 mmHg during the baseline periods for both groups and decreased to approximately 85 mmHg in those hearts subjected to ischemic arrest. In both groups, PSP increased approximately 14% at the 1 micrograms/ml concentration of milrinone. No additional increases in PSP were observed in the control group at the higher concentrations. However, PSP increased 28% and 41% (p less than 0.05), in the postischemia group at the 10 and 100 micrograms/ml concentrations, respectively. The CF averaged approximately 3 ml/min/g during the baseline periods of both groups and increased significantly at each milrinone concentration. The HR in both groups increased to approximately 200 and approximately 250 beats/min at the 10 and 100 micrograms/ml concentrations, respectively. Additionally, milrinone's effects in intact hearts were found to be comparable to those of isobutylmethyl xanthine (IBMX), a nonspecific PDE inhibitor. In isolated myocytes, however, milrinone produced only modest increases in cAMP levels, compared to IBMX.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N T Ross-Ascuitto
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA 70112
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15
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Abstract
At least four different isoforms of phosphodiesterases (PDEs) are responsible for the hydrolysis of cAMP in cardiac cells. However, their distribution, localization and functional coupling to physiological effectors (such as ion channels, contractile proteins, etc.) vary significantly among various animal species and cardiac tissues. Because the activity of cardiac Ca2+ channels is strongly regulated by cAMP-dependent phosphorylation, Ca(2+)-channel current (ICa) measured in isolated cardiac myocytes may be used as a probe for studying cAMP metabolism. When the activity of adenylyl cyclase is bypassed by intracellular perfusion with submaximal concentrations of cAMP, effects of specific PDE inhibitors on ICa amplitude are mainly determined by their effects on PDE activity. This approach can be used to evaluate in vivo the functional coupling of various PDE isozymes to Ca2+ channels and their differential participation in the hormonal regulation of ICa and cardiac function. Combined with in vitro biochemical studies, such an experimental approach has permitted the discovery of hormonal inhibition of PDE activity in cardiac myocytes.
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Affiliation(s)
- R Fischmeister
- Laboratoire de Physiologie Cellulaire Cardiaque, INSERM U-241, Université de Paris-Sud, Orsay, France
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