Beneficial effects of prostaglandin E1 on myocardial energetics and pump performance in severe CHF.

To provide more effective vasodilator agents for the therapy of severe left ventricular (LV) failure the cardiocirculatory actions of prostaglandin E1 (PGE1) were evaluated in nine coronary patients. PGE1 infusion modestly decreased mean systemic blood pressure (85 to 76 mm Hg, p less than 0.025) and LV filling pressure (19 to 15 mm Hg, p less than 0.01) while heart rate was unchanged (p less than 0.05). Simultaneously, PGE1 augmented cardiac index from 1.9 to 2.5 1/min/m2 (p less than 0.005), raised stroke index from 28 to 35 ml/beat m2 (p less than 0.01) and increased stroke work index from 26 to 30 g-m/m2 (p less than 0.02). Additionally, total systemic vascular resistance decreased from 1862 to 1282 dynes-sec-cm-5 (p less than 0.02) and double product of heart rate and systolic blood pressure diminished from 9492 to 8278 mm Hg (p less than 0.02) while the effective endocardial perfusion pressure was maintained (p less than 0.05). Concomitantly, forearm vascular resistance fell, forearm blood flow was raised, and forearm venous tone remained unchanged. Thus, our results demonstrate that PGE2 is a potent arteriolar vasodilator with markedly beneficial effects of myocardial energetics and on cardiac function in patients with severe ischemic congestive cardiac failure.