Perez-Baliño N A, Masoli O H, Meretta A H, Rodriguez A, Cragnolino D E, Perrone S, Boullon F, Mele E, Palacios I, Brown K A
Cardiology Unit, Sanatorio Anchorena, Buenos Aires, Argentina.
J Am Coll Cardiol. 1996 Nov 15;28(6):1488-92. doi: 10.1016/s0735-1097(96)00332-4.
This study sought to determine whether the response to amrinone in patients with severe baseline left ventricular dysfunction can predict improvement in left ventricular ejection fraction after coronary artery bypass graft surgery.
Previous studies have suggested that the inotropic response to dobutamine can identify viable myocardium in the setting of chronic coronary disease and left ventricular dysfunction. However, increased oxygen demand stimulated by dobutamine can lead to superimposition of ischemia on the hibernating state, potentially confounding interpretation of results. Amrinone is an inotropic agent that does not critically augment myocardial oxygen demand and may be useful for identification of hibernating myocardium in the chronically ischemic state.
Forty-four consecutive patients with coronary artery disease and left ventricular ejection fraction < 40% referred for coronary artery bypass graft surgery underwent amrinone stimulation (1 mg/kg body weight). Left ventricular ejection fraction was determined before amrinone stimulation, 20 min after infusion and 21 days after bypass surgery.
Baseline ejection fraction was 28 +/- 7% (mean +/- SD). Ejection fraction increased to 35 +/- 5% after amrinone stimulation (p < 0.0001) and to 33 +/- 6% after bypass surgery (p < 0.0001). Postbypass ejection fraction was significantly correlated with postamrinone ejection fraction (r = 0.65, p < 0.0001). Furthermore, the change in ejection fraction from baseline to after bypass surgery was highly correlated with the change in ejection fraction after amrinone stimulation (r = 0.75, p < 0.0001). Of 13 patients with an increase in ejection fraction > or = 10% after amrinone, all 13 had an increase of at least 8% and 11 (85%) of 13 had an increase > or = 10% after bypass surgery. In contrast, of 31 patients with an increase in ejection fraction < 10% after amrinone, only 2 (6%) had an increase > or = 10% (p < 0.0001) and 28 (90%) of 31 had an increase < 5% after bypass surgery.
Augmentation of myocardial contraction by amrinone in patients with chronic coronary artery disease and severe baseline left ventricular dysfunction predicts improvement in left ventricular ejection fraction after coronary artery bypass graft surgery.
本研究旨在确定重度基线左心室功能不全患者对氨力农的反应是否能够预测冠状动脉旁路移植术后左心室射血分数的改善情况。
既往研究提示，多巴酚丁胺的正性肌力反应可用于识别慢性冠状动脉疾病及左心室功能不全情况下的存活心肌。然而，多巴酚丁胺刺激引起的氧需求增加可导致冬眠状态下的心肌缺血叠加，可能混淆结果的解读。氨力农是一种不显著增加心肌氧需求的正性肌力药物，可能有助于识别慢性缺血状态下的冬眠心肌。
44例因冠状动脉疾病且左心室射血分数<40%而接受冠状动脉旁路移植术的连续患者接受氨力农刺激（1mg/kg体重）。在氨力农刺激前、输注后20分钟及旁路手术后21天测定左心室射血分数。
基线射血分数为28±7%（均值±标准差）。氨力农刺激后射血分数增至35±5%（p<0.0001），旁路手术后增至33±6%（p<0.0001）。旁路手术后的射血分数与氨力农刺激后的射血分数显著相关（r=0.65，p<0.0001）。此外，从基线至旁路手术后射血分数的变化与氨力农刺激后射血分数的变化高度相关（r=0.75，p<0.0001）。在氨力农刺激后射血分数增加≥10%的13例患者中，13例患者在旁路手术后射血分数均至少增加了8%，其中11例（85%）增加≥10%。相比之下，在氨力农刺激后射血分数增加<10%的31例患者中，只有2例（6%）在旁路手术后增加≥10%（p<0.0001），31例中的28例（90%）在旁路手术后增加<5%。
慢性冠状动脉疾病及重度基线左心室功能不全患者中，氨力农增强心肌收缩可预测冠状动脉旁路移植术后左心室射血分数的改善情况。
