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CARDIOVASCULAR ANESTHESIA

Does Dobutamine Improve Ventricular Function in Dogs with Regional Myocardial Dysfunction?

David P. Strum, MD, FRCP(C)^*, and Michael R. Pinsky, MD, CM

*Department of Anesthesiology and Critical Care Medicine, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada; and Cardiopulmonary Research Laboratory, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Address correspondence and reprint requests to David P. Strum, MD, Department of Anesthesiology, Kingston General Hospital, 76 Stuart St., Kingston, Ontario K7L 2V7. Address e-mail to strumd{at}post.queensu.ca

We studied the effect of systemic dobutamine infusion (4 µg · kg^-1 · min^-1 IV) on regional wall motion abnormalities (RWMAs) in eight anesthetized open-chested dogs. We hypothesized that infusion of small doses of dobutamine would reduce RWMAs and improve global ventricular function. Apical RWMAs were induced by local intracoronary boluses of 9.0 mg esmolol. Phase angles, effective stroke volume (SV), maximum SV, stroke work, and segmental shortening were compared among four left ventricular (LV) regions (apical, papillary, chordal, and basal) during baseline, dobutamine, esmolol, and dobutamine-esmolol treatments. The minimal global LV volume was designated as 0°, and the cardiac cycle was divided into 360 intervals. Regional phase angles were defined as the distance (in degrees) that regional minimum volume differed from global minimal LV volume (end-systole). RWMA decreased blood pressure (92 ± 2 mm Hg to 84 ± 3 mm Hg) and increased LV end-diastolic pressure (1.8 ± 0.5 mm Hg to 4.2 ± 0.8 mm Hg). RWMA delayed regional contraction (-2.9° ± 1.6° to 52.3° ± 1.5°) and decreased effective SV (2.3 ± 0.4 mL to 1.6 ± 0.3 mL) in the affected apical region but did not decrease maximal SV. Systemic infusion of dobutamine restored global LV function but failed to eliminate RWMA, as evidenced by decreased apical synchrony, effective SV, and stroke work. We concluded that systemic dobutamine restored global LV function but failed to correct RWMA.

IMPLICATIONS: We examined the effect of systemic dobutamine on regional wall motion abnormalities (RWMAs) induced by intracoronary esmolol infusion in eight anesthetized dogs. Esmolol dilated the heart and decreased regional synchrony of contraction. Dobutamine restored cardiac function but failed to correct the asynchrony of regional contraction caused by esmolol-induced RWMAs.

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