The effects of anisodamine and dobutamine on gut mucosal blood flow during gut ischemia/reperfusion

AIM: To determine if anisodamine is able to augment mucosal perfusion during gut I/R ischemia-reperfusion. METHODS: A jejunal sac was formed in Sprague Dawley rat. A Laser Doppler probe and a tonometer were inserted into the sac which was filled with saline. The superior mesenteric artery was occluded (SMAO)for 60 minutes followed by 90 minutes of reperfusion. At the end of 60 minutes of SMAO, either 0.2 mg/kg of anisodmine or dobutamine was injected into the jejunal sac. Laser Doppler mucosal blood flow and regional PCO2 (PrCO2)measurements were made. RESULTS: Mucosal blood flow was significantly increased at 30,60 and 90 minutes of reperfusion (R30, R60, R90) when intraluminal anisodamine or dobutamine was present compared to intraluminal saline only(44+/-3.3% or 48+/-4.1% vs 37+/-2.6% at R30, 57+/-5.0% or 56+/-4.7% vs 45+/-2.7% at R60, 64+/-3.3% or 56+/-4.2% vs 48+/-3.4% at R90,respectively P【0.05). Blood flow changes were also reflected by lowering of jejunal PrCO2 measurements after intraluminal anisodamine or dobutamine compared with that of the saline controls (41+/-3.1 mmHg or 44+/-3.0 mmHg vs 49+/-3.7 mmHg at R30,38+/-3.7 mmHg or 40+/-2.1 mmHg vs 47+/-3.8 mmHg at R60,34+/-2.1 mmHg or 39+/-3.0 mmHg vs 46+/-3.4 mmHg at R90, respectively, P【0.05). Most interesting finding was that there were significantly higher mucosal blood flow and lower jejunal PrCO2 in anisodamine group than those in dobutamine group at 90 minutes of reperfusion(64+/-3.3% vs 56+/-4.2% for blood flow or 34+/-2.1 mmHg vs 39+/-3.0 mmHg for PrCO2, respectively, P【0.05), suggesting that anisodamine had a more lasting effect on mucosal perfusion than dobutamine. CONCLUSION: Intraluminal anisodamine and dobutamine can augment mucosal blood flow during gut I/R and alleviate mucosal acidosis. The results provided beneficial effects on the treatment of splanchnic hypoperfusion following traumatic or burn shock.

Inhibitory effects of dobutamine on human gastric adenocarcinoma

AIM: To explore the inhibitory effects of dobutamine on gastric adenocarcinoma cells.

Effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia

Objective:To study the effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia.Methods:A total of 70 children with congenital heart disease and pneumonia in our hospital from June 2014 to Octomber 2016 were enrolled in this study. The subjects were divided into the control group (n=35) and the treatment group (n=35) randomly. The control group was treated with dobutamine, the treatment group were treated with dobutamine combined with meropenem. The two groups were treated for 10 days. The serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before and after treatment were compared.Results: There were no significantly differences of the serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before treatment. The serum BNP, TNF-a, IL-6 and hs-CRP levels of the two groups after treatment were significantly lower than before treatment, the serum IGF-1 and IGFBP-3 levels of the two groups after treatment were significantly higher than before treatment, and that of the treatment group were significantly better than the control group.Conclusion:Dobutamine combined with meropenem can significantly reduce the serum BNP, TNF-a, IL-6 and hs-CRP levels, improve serum IGF-1 and IGFBP-3 levels of children with congenital heart disease and pneumonia, and it was worthy clinical application.

Optimization and validation of a fast RP-HPLC method for the determination of dobutamine in rat plasma:Pharmacokinetic studies in healthy rat subjects

A novel isocratic reverse phase high performance liquid chromatography （RP-HPLC） with photo diode array （PDA） detection method for the determination of dobutamine （DBT） in rat plasma was developed and validated after optimization of various chromatographic conditions and other experimental parameters. Homoveratrylamiue was used as an internal standard. Methanol was used as the extracting solvent for the preparation of plasma samples. Samples were separated on a Symmetry C18 （250ram x4.6mm i.d., 5 pro） analytical column. Acetonitrile and 15raM potassium dihydrogen phosphate （pH 5.0 with 0.3% TEA） （20：80, v/v） was used. The column oven temperature was optimized at 35 ~C and the flow rate was 0.8 mL/min. The detection wavelength was fixed at 230 nm for entire analysis. The calibration curve was found to be linear over the concentration range of 50-2000 ng/mL （ra=0.9992）. The limit of quantification （LOQ） of the method was 50 ng/mL. The % RSD values of accuracy and precision values for intra and inter days were 〈 15% at quality control （QC） concentrations. Recovery, stability and robustness were studied within the acceptable range according to ICH guidelines. The method was efficiently applied to a pharmacokinetic study in healthy Wistar rats.

Value of Low Dose Dobutamine Doppler Tissue Imaging for Detecting Hibernating Myocardium

Summary: In order to assess the value of Doppler tissue imaging (DTI) in detecting viable hibernating myocardium, 20 patients with coronary artery disease and chronic left ventricular dysfunction underwent low dose dobutamine stress echocardiography and low dose dobutamine stress DTI. The results showed that among the 100 asynergic segments, 35 segments showed improvement after dobutamine infusion (group H) and no changes were observed in the remaining 65 segments (group N). The left ventricular echocardiographic score index decreased from 1.60±0. 35 to 1.44±0.36 ( n =20, P <0.01). During low dose dobutamine stress DTI, there was no difference in the values of velosity of S wave (V s) before dobutamine infusion between two groups. However, after dobutamine infusion, the values of V s and VR in group H were significantly higher than those in group N (V s:10.1±3.0 cm/s vs 7.3±2.2 cm/s, P <0.01; VR: 60 %±41 % vs 25 %±32 %, P <0.001). 95.7 % asynergic myocardial segments with VR≤0 had no viability while 86 % asynergic segments with VR>80 % were viable myocardium. It is concluded that the different reactions to dobutamine stress between hibernating and necrosis myocardium could be showed by DTI and it is more clinically significant when VR≤0 and VR>80 %.

Dobutamine Infusion and Absence of Pulmonary Hypertension Are Associated with Decreased Mortality in a Cohort of 249 Patients with Cardiogenic Shock

Objective: Prognostic analysis of 249 patients admitted for cardiogenic shock (CS) of various origins. Background: Little is known about prognosis of CS from non-ischemic cardiomyopathy. Methods: Retrospective monocentric study of patients referred to an ICU during 2 years. Results: Despite aggressive management including intra-aortic balloon pump (31%), extra-renal replacement therapy (36%), extra-corporeal life support (8%), and catecholamine infusion (97%), in-hospital mortality was 46%. Toxic CS or CS related to deficiency carried a better outcome (mortality 5%). Post-myocardial infarction or post-cardiac arrest CS was associated with higher mortality. In the multivariate analyses, only SAPS II (OR 1.037;1.013 - 1.056;p = 0.0001), pulmonary hypertension (OR 4.8;1.3 - 17;p = 0.02), extra-renal replacement therapy (OR 2.9;1.3 - 6;p = 0.006), and dobutamine infusion (OR 0.44;0.2 - 0.96;p = 0.04) were significantly associated with in-hospital mortality. Conclusion: Dobutamine infusion was associated with a better outcome. Higher SAPS II, pulmonary hypertension, and extra-renal replacement therapy were associated with increased in-hospital mortality.

The Value of Speckle Tracking Strain Imaging at Recovery Period of Dobutamine Stress Echocardiography

Background: Dobutamine stress echocardiography (DSE) is a well-established method for detecting myocardial ischemia. The classic echocardiographic findings of ischemia are new or worsening abnormalities of radial wall thickening. However, interpretation of these findings is subjective and dependent on experience. Speckle tracking strain imaging (STI) has been introduced as a novel method to overcome these limitations. Objective: The aim of the study is to evaluate the value of speckle tracking imaging (STI) by estimating the mean global longitudinal systolic (GLS) and the mean global circumferential systolic (GCS) strain imaging at recovery period of dobutamine stress echocardiography for prediction of significant coronary artery disease (CAD) in patients with chest discomfort. Methods: Fifty three patients presented for evaluation of chest discomfort underwent dobutamine stress echocardiography and coronary angiography at Cardiology Department,Menoufia University Hospital. The mean global left ventricular longitudinal systolic strain (GLS) at apical views—3 chambers, 4 chambers & 2 chambers apical views and global left ventricular circumferential systolic strain (GCS) at short axis view at level of papillary muscle were measured at rest and during recovery period of dobutamine stress echocardiography using automated functional imaging (AFI). Coronary angiography was done for all patients. Significant coronary artery lesion was defined as having a ≥ 70% diameter stenosis on coronary angiography. Patients were divided into two groups based on the presence or absence of significant coronary artery lesion into CAD positive (+ve) group vs. CAD negative (-ve) group. Results: In both groups,there were no statistically significant differences in the clinical characteristics and baseline conventional transthoracic echocardiography. GLS and GSC at recovery were lower in the CAD (+ve) group than in the CAD (-ve) group (-16.69% ± 1.10% vs -19.05% ± 1.41% p ). GLS and GCS during recovery period of DSE were valuable for prediction of CAD when cutoff at recovery is less than -17.95% (sensitivity of 84% & specificity of 84%) for GLS and less than -20.2% (sensitivity of 76% & specificity of 84%) for GCS. Also, we observed that the GLS and GCS percentile decreased from baseline to recovery period of DSE by about -9.95% ± 4.82% and -7.72% ± 3.90% respectively. Conclusion: Speckle tracking Imaging GLS and GCS at recovery period of Dobutamine Stress Echocardiography is feasible and offers an objective technique for prediction of significant coronary artery disease with increasing the accuracy of DSE in patient with chest discomfort.

Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease

Background: Coronary artery disease (CAD) is often silent in diabetic patients, and it is typically in ad-vanced stages of development by the time it manifests. Various forms of stress testing have been investigated to detect obstructive CAD in diabetes mellitus. Ob-jectives: To assess the diagnostic value of dobutamine stress pulsed-wave Doppler tissue imaging (DTI) compared with standard wall motion analysis in de-tection of myocardial ischemia in diabetic patients with suspected CAD. Methods: The study comprised 46 diabetic patients with suspected CAD underwent dobutamine stress echocardiography (DSE) with DTI within 4 weeks before coronary angiography(CA). Dobutamine infusion started at 5 μ/kg/min and in-creased up to 40 μ/kg/min with additional atropine during submaximal heart rate responses. In addition to wall-motion score index (WMSI) analysis, pulsed- wave DTI examination of basal and mid segments of posteroseptal, lateral, anterior, inferior and antero- septal walls was performed. Myocardial velocities were measured at rest in the apical 4, 3 and 2-cham- ber views. The measurements were repeated at low dose (10 - 15 μ/kg/min) and at peak stress (40 μ/kg/min). DTI measurements included peak systolic velocity (S), peak early diastolic velocity (E) and peak late diastolic velocity (A) and the results were com-pared to WMSI analysis. Patients were classified into two groups according to CA results;group (I) di-abetics with positive CA (n = 27) and group (II) di-abetics with negative CA (n = 19). Results: There was no significant difference between the two groups in duration of diabetes, global WMSI at rest or the ? changes (stress-rest/rest) of WMSI (P > 0.05). Global S and global E were significantly lower in group I compared to group II at peak stress (11.3 ± 3.7 cm/sec vs. 14.5 ± 2.2 cm/sec, p < 0.01) and (11.3 ± 1.6 cm/sec vs. 13.1 ± 2.1 cm/sec, p < 0.01) respectively. The cutoff points for global S and global E to detect obstructive CAD in diabetics were 11.3 cm/s and 11.2 cm/s re-spectively with 75.7%, 73.4% sensitivity and 94.7%, 89.47% specificity respectively. An increment (? changes) less than 0.56 in S or 0.26 in E from rest to peak stress identified CAD with 78.8 %, 89.3% sensi-tivity and 94.7%, 90.7% specificity respectively. The accuracy of DTI parameters during peak stress was higher than WMSI analysis (sensitivity 74.1% vs. 59.3% and specificity 90% vs. 79%, P < 0.01 for each). In multivariate regression analysis, only ?S and ?E were independent predictors of obstructive CAD in diabetics (odd ratio: 36.16, 95% CI, 1.34- 532.01 and 63.77, 95% CI, 3.19-721.47) respectively. Conclusion: Quantitative analysis, using DTI during DSE, adds new dimension in diagnosis of myocardial ischemia. It is more sensitive, specific, accurate and reproducible compared with standard wall motion analysis for recognition of significant CAD in diabetic patients.

Prognostic Utility of Dobutamine Stress Echocardiography in the Obese African American Population

Background: The predictive value of Dobutamine Stress Echocardiography (DSE) in the obese African American patient population is not well known. Methods: We conducted a retrospective study of 555 African American patients between 1/1/2001-12/31/2001. DSE responses were classified into normal, ischemia, scar, or scar +/? ischemia. End-points utilized were all cause death (ACD) and major adverse cardiac events (MACE). Results: There were a total of 409 obese patients and 146 non-obese patients. By multi-variate analysis only the scar group in the obese population predicted ACD (p = 0.003) and combined MACE (p = 0.014). Kaplan Meir analysis demonstrated that only the scar group was associated with decrease in freedom from all cause death (p < 0.001) and combined MACE (p < 0.001). Conclusion: DSE retains its prognostic power in the obese African American population and scar has important impli-cations for MACE.

Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials

Objective: To evaluate the clinical efficacy of levosimendan versus dobutamine in critically ill patients requiring inotropic support. Methods: Clinical trials were searched in PubMed, EMBASE, and the Cochrane Central Registry of Clinical Trials, as well as Web of Science. Studies were included if they compared levosimendan with dobutamine in critically ill patients requiring inotropic support, and provided at least one outcome of interest. Outcomes of interest included mortality, incidence of hypotension, supraventricular arrhythmias, and ventricular arrhythmias. Results: Data from a total of 3052 patients from 22 randomized controlled trials (RCTs) were included in the analysis. Overall analysis showed that the use of levosimendan was associated with a significant reduction in mortality (269 of 1373 [19.6%] in the levosimendan group, versus 328 of 1278 [25.7%] in the dobutamine group, risk ratio (RR)=0.81, 95% confidence interval (CI) 0.70-0.92, P for effect=0.002). Subgroup analysis indicated that the benefit from levosimendan could be found in the subpopulations of cardiac surgery, ischemic heart failure, and concomitant β-blocker therapy in comparison with dobutamine. There was no significant difference in the incidence of hypotension, supraventricular arrhythmias, or ventricular arrhythmias between the two drugs. Conclusions: In contrast with dobutamine, levosimendan is associated with a significant improvement in mortality in critically ill patients requiring inotropic support. Patients having cardiac surgery, with ischemic heart failure, and receiving concomitant β-blocker therapy may benefit from levosimendan. More RCTs are required to address the questions about no positive outcomes in the subpopulation in a cardiology setting, and to confirm the advantages in long-term prognosis.

Comparison of adenosine stress and dobutamine stress by real-time myocardial contrast echocardiography in detecting myocardium ischemia in dogs

Background Real-time perfusion imaging （RTPI） using ultrasound contrast agents has shown good ＂accuracy＂ in detecting myocardial infarction, however its accuracy in the assessment of peri-infarct ischemia and stress echocardiography are not known. The aim of this study was to determine the accuracy of RTPI in assessment of peri-infarct ischemia during dobutamine and adenosine stress. Methods We employed the RTPI modality （Agilent and ATL Philips） in a canine model （18 dogs） of distal coronary occlusion and proximal coronary stenosis. Using coronary flow probe recordings, the physiologic significance of proximal coronary stenosis was established by confirming abolition of the coronary reserve. The contrast agent Optison was given as a slow bolus injection at baseline, during prolonged distal coronary occlusion, during adenosine bolus stress and during dobutamine stress. Triphenyltetrazolium chloride （TTC） staining was used to verity a distal infarction. RTPI recordings at baseline, the distal coronary occlusion and stress protocols were randomly mixed and reviewed blindly. Results In all but one dog, RTPI detected a distal infarct as small as 9% of the left ventricle. The sensitivity, specificity and overall diagnostic accuracy of RTPI in the detection of distal infarcts were： 94%, 89% and 92%, respectively. The sensitivity, specificity, and overall diagnostic accuracy of RTPI in the assessment of peri-infarction ischemia were 83%, 92% and 88% for adenosine stress and 95%, 86% and 91% for dobutamine stress, respectively. Conclusions Even small distal infarcts can be detected by RTPI; peri-infarct ischemia can be accurately recognized by RTPt during stress; adenosine and dobutamine stress appear equally reliable in the RTPI evaluation of peri-infarct ischemia.

Detection of viable myocardium by low dose of dobutamine cine MR imaging in miniswine

Objective To evaluate the diagnostic value of dobutamine stress magnetic resonance imaging (MRI) for myocardial viability.Methods Ten male miniswines underwent left ventriculography and coronary angiography, followed by stenosis of the left circumflex coronary artery (LCX) using ameroid constrictor. More than one month later, left ventriculography and coronary angiography were performed again, followed by cine-MRI at rest and during stress with incremental dose of dobutamine 5 -20 μg·kg-1·min-1. Traditional and/or breath-hold cine-MRI were used to evaluate regional left ventricular wall motion, corresponding to basal, midventricular and apical short-axis tomograms. Regional wall motion score index (WMSI) was calculated. The miniswines were finally sacrificed for pathological examination. Triphenyl tetrazolium chloride ( TTC) delineated myocardial infarction. Microscopy was used to identify myocardial cellular changes.Results One pig died, one pig suffered from aneurysm and another showed no negative findings. The other seven pigs were found with hypokinetic (n = 4) or akinetic (n = 3) myocardial regions related to stenosed LCX. Their mean WMSI at rest for the lateral and posteroinferior walls (ischemic regions) of the left ventricle was 2. 27±0.32, as compared with 1. 00±0. 00 ( P < 0. 01) for the corresponding nonischemic anteroseptal regions. Further, the mean WMSI for the ischemic regions was 2. 27±0. 32 at rest compared with 1. 40±0. 39(P<0. 01) at the dose of dobutamine 5 μg·kg-1 ·min-1. However, the mean WMSI at the doses of dobutamine 10 and 20 μg·kg-1·min-1 were 1. 70±0. 76 and 1. 75±0. 83, respectively, with no significant difference as compared with the mean WSCI at rest (P>0. 05). The pathologic examination showed viable myocardium at the ischemic regions.Conclusion Low-dose dobutamine (5μg·kg-1·min-1) recovers hypokinetic or akinetic myocardial regions, and dobutamine stress MRI can be used to detect myocardial viability.

Usefulness of dobutamine stress myocardial contrast echocardiography for assessing coronary artery disease

Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease （ CAD）, and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography （RT-MCE） in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve. Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta （0.28± 0. 12, 0. 25± 0. 09, 0.22 ± 0. 06, 0. 20± 0.07 respectively, P 〈0. 01） and A x beta （1.37 ±0. 46, 1.28±0. 47, 1. 13 ±0. 37, 0.91±0. 32, respectively, P 〈0. 01 ） were observed among four segment groups with graded coronary artery stenosis severity （normal; 30% -69% stenosis; 70% -90% stenosis; and beyond 90% stenosis） , but not observed in parameter A. When under stress, significant differences in A （5.73 ± 1.28, 5.63 ± 1.01,4.96 ±0.81,4.57 _＋0.62, respectively, P〈0.01）, beta （0.67 ±0. 17, 0.55 ±0. 19, 0.32 ±0. 13, 0.25 ±0.08, respectively, P 〈0.01） and A x beta （3.81 ± 1.20, 3. 11±1.17, 1.59 ±0. 82, 1. 12 _＋0. 37, respectively, P 〈0. 01 ） were observed among the formerly mentioned groups. Graded decreases in A reserve （ 1.20 ±0. 53, 1.11 ±0. 16, 0.98 ±0. 12, 0. 99 ±0.13, respectively, P〈0.01）, beta reserve （2.65 ±1.07, 2. 32±0.82, 1.44±0.40, 1.29±0.34, respectively, P〈0.01） and A xbeta reserve （3.05 ± 1.63, 2.59 ±1.01, 1.42 ±0.44, 1.27±0.34, respectively, P 〈 0. 01 ） could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS （ 1 - 5 ） , concordance between contractile function and myocardial perfusion could be found both at rest （beta： 0.28±0. 11, 0. 22 ±0. 08, 0. 21 ±0.05, 0. 17 ±0.05,0. 19 ±0.06, respectively, P 〈0.01; A xbeta： 1.29 ±0.48, 0.98 ±0.45, 0.94±0.29, 0.76 ±0.30, 0.92 ±0.32, respectively, P〈 0.01） and under stress （beta： 0.59 ±0.20, 0.35 ±0.15, 0.27 ±0.08, 0. 17±0.05, 0.20±0.05, respectively, P〈0.01; A xbeta： 3.07 ±1.38, 1.62±0.82, 1.28 ±0.40, 0.78 ±0.24, 0.93 v0.22, respectively, P 〈0. 01 ）. This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation.

Evaluation of cardiac betaadrenergic receptor function in chi ldren by dobutamine stress echocardiography

Objective To investigate the role of dobutamine stree echocardiography in evaluating cardiac betaadrenergic receptor (AR) function and responsive ness in children Methods Left ventricular ejection fraction (EF), fractional shortening (FS), left ventricular end systolic volume index (ESVI), the ratio of systolic b lood pressure and ESVI (SP/ESVI) were measured by dobutamine stress echocardiogr aphy (DSE) in 30 children with AR hypersensitivity, 15 children with dilated cardiomyopathy and 30 normal children respectively Results Before pharmacological stress, EF and FS were 072 and 039 r es pectively in AR hypersensitivity group versus 070 and 035 respectively i n control group There was no difference of the indices between the two groups ( P >005) SP/ESVI was 076, higher than the value of 066 in co ntro l group ( P <005); EF, FS and SP/ESVI were 041, 015 and 01 0 re spectively, which were significantly lower than those in control group After d o butamine stress of 5?gkg-1min-1 and 10?gkg-1min -1, EF, FS and SP/ESVI were sig nificantly increased in patients with AR hypersensitivity and there were no changes in children with dilated cardiomyopathy compared with values of baseline Conclusion Cardiac AR function and responsiveness can be evaluated by dobutamine stress echocardiography

Detecting residual ischemia and identifying coronary artery disease after myocardial infarction using dobutamine technetium-99m-MIBI SPECT

To evaluate dobutamine technetium 99m methoxy isobutyl nitrile (sestamibi) single photon emission computed tomography (Dobu ECT) in detecting residual ischemia and identifying coronary vessel disease after myocardial infarction Methods Sixty two patients with confirmed myocardial infarction were studied with Dobu ECT at the time of coronary artery angiography Dobutamine was administered intravenously in incremental rates from 5 to 40?μg· kg 1 ·min 1 at 3 minute intervals At the highest infusion rate, 7 4×10 8 Bq 99m Tc MIBI was injected intravenously, and tomographic imaging was performed after one hour Resting images were taken after 24 hours, with a second dose of 99m Tc MIBI Results The sensitivity of Dobu ECT in detecting residual ischemia of myocardial infarction was 76%, which was higher than dobutamine electrocardiography (Dobu ECG) Regardless of the single , double or triple vessel diseases, Dobu ECT was superior to Dobu ECG in identifying residual ischemia (56% vs 4%, 86% vs 27%, 100% vs 47%, P <0 01, respectively) The incidence of residual ischemia in patients receiving thrombolytic therapy was 67%, lower than patients without thrombolysis (72%) or those with an old myocardial infarction (94%) But the differences were not statistically significant Dobu ECT detected only 56% of ischemias in non infarct related myocardium Eighty two percent of all significantly stenosed vessels were detected with Dobu ECT, and 84% of patients with multivessel disease could be accurately identified The sensitivity of Dobu ECT was significantly greater for detecting severe stenosis over moderate stenosis The sensitivity for detecting stenosis in the right coronary artery was greater than left anterior descending or left circumflex, but its specificity was lower Conclusion Dobu ECT can identify residual ischemia, as well as its location and extent after myocardial infarction Dobu ECT can also accurately detect significantly stenosed vessels

Cirrhotic cardiomyopathy:Isn't stress evaluation alwaysrequired for the diagnosis?

AIM:To describe the proportion of patients with cirrhotic cardiomyopathy(CCM) evaluated by stress echocardiography and investigating its association with the severity of liver disease.METHODS:A cross-sectional study was conducted.Cirrhotic patients without risk factors for cardiovascular disease were included.Data regarding etiology and severity of liver disease(Child-Pugh score and model for end-stage liver disease),presence of ascites and gastroesophageal varices,pro-brain natriuretic peptide(proBNP) and corrected QT(QTc) interval were collected.Dobutamine stress echocardiography(conventional and tissue Doppler imaging) was performed.CCM was considered present when diastolic and/or systolic dysfunction was diagnosed at rest or after pharmacological stress.Therapy interfering with cardiovascular system was suspended 24 h before the examination.RESULTS:Twenty-six patients were analyzed,17(65.4%) Child-Pugh A,mean model for end-stage liver disease(MELD) score of 8.7.The global proportion of patients with CCM was 61.5%.At rest,only 2(7.7%)patients had diastolic dysfunction and none of the patients had systolic dysfunction.Dobutamine stress echocardiography revealed the presence of diastolic dysfunction in more 6(23.1%) patients and of systolic dysfunction in 10(38.5%) patients.QTc interval prolongation was observed in 68.8%of the patients and increased pro-BNP levels in 31.2%of them.There was no association between the presence of CCM and liver impairment assessed by Child-Pugh score or MELD(P= 0.775,P= 0.532,respectively).Patients with QTc interval prolongation had a significant higher rate of gastroesophageal varices comparing with those without QTc interval prolongation(95.0%vs 50.0%,P= 0.028).CONCLUSION:CCM is a frequent complication of cirrhosis that is independent of liver impairment.Stress evaluation should always be performed,otherwise it will remain an underdiagnosed condition.

Should dopamine be the first line inotrope in the treatment of neonatal hypotension? Review of the evidence

AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases searched were MEDLINE and the Cochrane Library, a total of 134 studies were identified. Only studies with high quality evidence(level 1a and b and 2a) were included. After review, only eight studies were included in the final analysis. Pooled risk ratios derived for each outcome [Mantel-Haenzel(M-H) fixed effect] with CI, as reported in the Cochrane reviews were plotted in forest plot form. RESULTS: Eight articles met inclusion criteria, which all included treatment in preterm infants. Dopamine increased mean arterial blood pressure(BP)(n = 163; r = 0.88, 95%CI: 0.76 to 0.94) and systolic BP(n = 142; r = 0.81, 95%CI: 0.42 to 0.94) comparing to placebo. Dopamine has been shown overall to be statistically more effective in increasing BP than dobutamine(n = 251, r = 0.26, 95%CI: 0.20-0.32). However there were no differences in short term outcomes(periventricular leucomalacia, periventricular haemorrhage) and mortality between both drugs. There is no statistical evidence of dopamine being more effective than adrenaline or corticosteroids. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone(RR 1.81, 95%CI: 0.18 to 18.39) or adrenaline. CONCLUSION: In preterms, dopamine is the most studied drug, and we suggest it could be used as first line treatment in hypotension.

Screening for cardiovascular disease before kidney transplantation

Pre-kidney transplant cardiac screening has garnered particular attention from guideline committees as an approach to improving post-transplant success. Screening serves two major purposes: To more accurately inform transplant candidates of their risk for a cardiac event before and after the transplant, thereby informing decisions about proceeding with transplantation, and to guide pre-transplant management so that posttransplant success can be maximized. Transplant candidates on dialysis are more likely to be screened for coronary artery disease than those not being considered for transplantation. Thorough history and physical examination taking, resting electrocardiography and echocardiography, exercise stress testing, myocardial perfusion scintigraphy, dobutamine stress echocardiography, cardiac computed tomography, cardiac biomarker measurement, and cardiac magnetic resonance imaging all play contributory roles towards screening for cardiovascular disease before kidney transplantation. In this review, the importance of each of these screening procedures for both coronary artery disease and other forms of cardiac disease are discussed.

Anisodamine augments mucosal blood flow during gut ischemia/reperfusion

Objective;To determine if anisodamine is able to augment mucosal perfusion during gut ischemia-reper-fusion (I/R).Methods;A jejunal sac was formed in Sprague Dawley rat.A Laser Doppler probe and a tonometerwere inserted into the sac which was filled with saline.The superior mesenteric artery was occluded (SMAO) for 60minutes followed by 90 minutes of reperfusion.At the end of 60 minutes of SMAO,either 0.2mg/kg of anisodmineor dobutamine was injected into the jejunal sac.Laser Doppler mucosal blood flow ...

Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.