Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction

Journal Article · Sun Dec 01 04:00:00 EST 1985 · Circulation; (United States)

DOI:https://doi.org/10.1161/01.CIR.72.6.1327· OSTI ID:5733634

Dell'Italia, L J; Starling, M R; Blumhardt, R; Lasher, J C; O'Rourke, R A

To assess the value of volume loading and to determine the relative efficacy of dobutamine compared with nitroprusside therapy in acute right ventricular infarction (RVMI), 13 patients with clinical, hemodynamic, and radionuclide angiographic evidence of RVMI were evaluated. In 10 patients who had an initial pulmonary arterial wedge pressure less than 18 mm Hg, volume loading did not improve cardiac index (1.9 +/- 0.5 (SD) to 2.1 +/- 0.4 liters/min/m2), despite significant increases in mean right atrial pressure (11 +/- 2 to 15 +/- 2 mm Hg, p less than .001) and pulmonary arterial wedge pressure (10 +/- 4 to 15 +/- 2 mm Hg, p less than .001). Nine patients received dobutamine or nitroprusside in random order, while hemodynamic measurements and radionuclide angiograms were obtained simultaneously. Compared with nitroprusside, dobutamine produced a statistically significant increase in cardiac index (2.0 +/- 0.4 to 2.7 +/- 0.5 vs 2.1 +/- 0.4 to 2.3 +/- 0.5 liters/min/m2, p less than .001), stroke volume index (29 +/- 6 to 36 +/- 8 vs 29 +/- 6 to 30 +/- 6 ml/m2, p = .02), and right ventricular ejection fraction (30 +/- 8% to 42 +/- 7% vs 34 +/- 8% to 37 +/- 4%, p less than .01) by two-way analysis of variance. We conclude that volume loading does not improve cardiac index in patients with acute RVMI despite a rise in cardiac filling pressures and that infusion of dobutamine, after appropriate volume loading, produces a significant improvement in cardiac index and right ventricular ejection fraction over those after infusion of nitroprusside.

• OSTI ID: 5733634
• Journal Information: Circulation; (United States), Journal Name: Circulation; (United States) Vol. 6; ISSN CIRCA
• Country of Publication: United States
• Language: English

Related Subjects

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62 RADIOLOGY AND NUCLEAR MEDICINE
BIOMEDICAL RADIOGRAPHY
BLOOD PRESSURE
BODY
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
CHEMOTHERAPY
COMPARATIVE EVALUATIONS
COMPLEXES
DIAGNOSTIC TECHNIQUES
DISEASES
ELEMENTS
FERRICYANIDES
HEART
INFUSION
INTAKE
IRON COMPLEXES
MEDICINE
METALS
MYOCARDIAL INFARCTION
NUCLEAR MEDICINE
ORGANS
PATIENTS
RADIOLOGY
TECHNETIUM
THERAPY
TRANSITION ELEMENT COMPLEXES
TRANSITION ELEMENTS