Mb. Patel et al., Sustained improvement in flow-mediated vasodilation after short-term administration of dobutamine in patients with severe congestive heart failure, CIRCULATION, 99(1), 1999, pp. 60-64
Citations number
17
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-In patients with severe congestive heart failure (CHF), short-te
rm administration of dobutamine exerts sustained clinical benefits that are
partially mediated by a training-like effect on skeletal muscle. Recently,
physical training has been shown to enhance endothelial function in the sk
eletal muscle vasculature by improving endothelial function. Whether the do
butamine-induced training effect is also associated with an improvement in
endothelial function in the skeletal muscle vasculature is currently unknow
n.
Methods and Results-Flow-mediated vasodilation in response to peak reactive
hyperemia was evaluated in the forearms of 9 patients with severe CHF who
were treated with dobutamine for 72 hours. Resting and peak hyperemic brach
ial artery blood flow and diameter (BABF [mL/min] and BAD [mm], respectivel
y) were measured by 2-dimensional and Doppler ultrasonography at baseline,
at 3 and 72 hours during dobutamine infusion, and at 2 and 4 weeks after di
scontinuation of dobutamine therapy. In addition, the brachial artery respo
nse to sublingual (SL) administration of nitroglycerin (NTG) was evaluated
at baseline and at 2 and 4 weeks after discontinuation of dobutamine therap
y, Ten patients with severe CHF who did not receive dobutamine served as co
ntrol subjects. Resting BABF was significantly increased at 3 and 72 hours
(391.2+/-31.8 and 366.8+/-31.0 mL/min, respectively, compared with 289.8+/-
18.6 mL/min at baseline; P<0.05), Peak hyperemic BABF was not altered by do
butamine infusion compared with baseline values. The increase in BAD during
peak hyperemic response was greater after infusion of dobutamine for 72 ho
urs (15.2+/-2.7% versus 9.1+/-1.8%, P<0.05) and remained significantly grea
ter for greater than or equal to 2 weeks after discontinuation of dobutamin
e (12.3+/-2.2% versus 9.1+/-1.8%, P<0.05). In contrast to the peak hyperemi
c response, the increase in BAD (%) induced by Si NTG was unchanged by admi
nistration of dobutamine for 72 hours. Two and 4 weeks after discontinuatio
n of dobutamine, NTG-induced increases in BAD were similar to the BAD noted
at baseline.
Conclusions-In patients with severe CHF, short-term administration of dobut
amine for 72 hours selectively improves vascular endothelial function for g
reater than or equal to 2 weeks.