Department of Anesthesiology, and Division of Critical Care, Montreal Heart Institute, Université de Montréal, Canada Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Canada
Department of Medicine and Critical Care Division, Hôpital du Sacré-Coeur, Université de Montréal, Canada.
Eur Heart J Acute Cardiovasc Care. 2015 Aug;4(4):316-25. doi: 10.1177/2048872614549102. Epub 2014 Sep 1.
Amiodarone is commonly used in the acute care setting. However the acute hemodynamic and echocardiographic effect of intravenous amiodarone administered intraoperatively on right ventricular (RV) systolic and diastolic function using transesophageal echocardiography (TEE) has not been described.
The study design was a randomized controlled trial in elective cardiac surgical patients undergoing valvular surgery. Patients received an intravenous loading dose of 300 mg of either amiodarone or placebo in the operating room, followed by an infusion of 15 mg/kg for two days. Hemodynamic profiles, echocardiographic measurement of RV and left ventricular (LV) dimensions, Doppler interrogation of tricuspid and mitral valve, hepatic and pulmonary venous flow combined with tissue Doppler imaging of the tricuspid and mitral valve annulus were obtained before and after bolus.
Although more patients in the placebo group had chronic obstructive lung disease (14 vs 6, p=0.05) and diabetes (14 vs 5; p=0.0244), there was no difference in terms of baseline hemodynamic, 2D and Doppler variables. After bolus, a significant increase in pulmonary artery pressure, central venous pressure and pulmonary vascular resistance index (p<0.05) was observed in the amiodarone group with reduction in systolic to diastolic (S/D) ratio of the hepatic (p=0.0247) and pulmonary venous (p=0.0052) velocity.
Acute administration of amiodarone is associated with alteration in RV diastolic properties and has minimal negative inotropic effect on RV systolic function in cardiac surgical patients with valvular disease.
胺碘酮常用于急性护理环境中。然而，经胸超声心动图（TEE）术中静脉给予胺碘酮对右心室（RV）收缩和舒张功能的急性血液动力学和超声心动图影响尚未描述。
该研究设计为择期心脏手术患者行瓣膜手术的随机对照试验。患者在手术室接受 300 毫克胺碘酮或安慰剂的静脉负荷剂量，然后在两天内输注 15 毫克/公斤。在推注前后获得血流动力学谱、RV 和左心室（LV）尺寸的超声心动图测量、三尖瓣和二尖瓣的多普勒询问、肝和肺静脉血流以及三尖瓣和二尖瓣瓣环的组织多普勒成像。
尽管安慰剂组中更多的患者患有慢性阻塞性肺疾病（14 例比 6 例，p=0.05）和糖尿病（14 例比 5 例；p=0.0244），但两组在基线血液动力学、二维和多普勒变量方面没有差异。推注后，胺碘酮组肺动脉压、中心静脉压和肺血管阻力指数显著升高（p<0.05），肝（p=0.0247）和肺静脉（p=0.0052）速度的收缩期至舒张期（S/D）比值降低。
心脏瓣膜疾病患者中，急性给予胺碘酮与 RV 舒张功能改变有关，对 RV 收缩功能的负性肌力作用最小。
