Inotropic stimulation by dobutamine increases left ventricular regional function at the expense of metabolism in hibernating myocardium

• Published in: The American heart journal 1996-09, Vol.132 (3), p.542-549
• Main Authors: Indolfi, Ciro, Piscione, Federico, Perrone-Filardi, Pasquale, Prastaro, Mariella, Di Lorenzo, Emilio, Saccà, Luigi, Salvatore, Marco, Condorelli, Mario, Chiariello, Massimo
• Format: Article
• Language: English
• Subjects: Aged; Anaerobiosis; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiotonic Agents - administration & dosage; Cardiotonic Agents - pharmacology; Cardiotonic Agents - therapeutic use; Coronary Circulation; Coronary Disease - complications; Coronary Disease - therapy; Coronary heart disease; Coronary Vessels; Dobutamine - administration & dosage; Dobutamine - pharmacology; Dobutamine - therapeutic use; Echocardiography; Fatty Acids, Nonesterified - blood; Glycolysis; Heart; Humans; Infusions, Intra-Arterial; Lactates - blood; Male; Medical sciences; Middle Aged; Myocardial Contraction - drug effects; Myocardium - metabolism; Prospective Studies; Rest; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left - drug therapy; Ventricular Dysfunction, Left - metabolism; Ventricular Function, Left - drug effects
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(96)90236-7

The mechanism by which dobutamine increases the contraction of chronically dysfunctional myocardium and its effects on metabolism are still unknown. The aim of this study was to assess regional myocardial metabolism at rest and during an intracoronary dobutamine infusion in patients with hibernating myocardium. Eleven asymptomatic patients with single proximal stenosis of the left anterior descending coronary artery and persistent left ventricular dysfunction at rest (undergoing percutaneous transluminal coronary angioplasty [PTCA]) were studied prospectively. Regional left ventricular function was assessed by two-dimensional (2D) echocardiography and regional perfusion by thallium-201 single-proton-emission computed tomography. Great cardiac vein and aortic blood samples were obtained for measurements of lactate and plasma free fatty acid (FFA) concentrations. Inotropic challenge, obtained by using intracoronary dobutamine infusion, increases regional left ventricular function. However, the arteriovenous AV lactate difference was 0.206 ± 0.070 mmol/L at rest, and it decreased to 0.018 ± 0.069 mmol/L ( p < 0.05 vs baseline) and 0.066 ± 0.068 mmol/L ( p < 0.05 vs baseline) at 4 and 10 minutes of dobutamine infusion, respectively. Thus the hibernating myocardium does not produce lactate at rest. However, when regional contraction is stimulated, dobutamine-induced inotropic challenge may cause a perfusion-contraction mismatch with an activation of anaerobic glycolysis.