Levosimendan is superior to epinephrine in improving myocardial function after cardiopulmonary bypass with deep hypothermic circulatory arrest in rats

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Presentation transcript:

Levosimendan is superior to epinephrine in improving myocardial function after cardiopulmonary bypass with deep hypothermic circulatory arrest in rats Alessio Rungatscher, MD, PhD, Daniele Linardi, MD, Maddalena Tessari, MSc, Tiziano Menon, MSc, Giovanni Battista Luciani, MD, Alessandro Mazzucco, MD, Giuseppe Faggian, MD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 1, Pages 209-214 (January 2012) DOI: 10.1016/j.jtcvs.2011.09.020 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Common clinical hemodynamic parameters at baseline normothermia, during hypothermia (recorded by temporarily turning off CPB at 20°C), and after rewarming. Values represent absolute changes (means ± standard deviations). ∗P < .05; ∗∗P < .01. CPB, Cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 209-214DOI: (10.1016/j.jtcvs.2011.09.020) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 End-systolic pressure–volume (P-V) relationship (ESPVR) and end-diastolic P-V relationship (EDPVR). Original recordings of representative P-V loops were obtained with a P-V conductance catheter system at different preloads during vena cava occlusion and showed differences in ESPVR and EDPVR between epinephrine- and levosimendan-treated rats. The increased slope steepness of ESPVR and decreased of EDPVR in levosimendan indicate improved contractile function and diminished diastolic stiffness, respectively. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 209-214DOI: (10.1016/j.jtcvs.2011.09.020) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Maximal slope of the systolic pressure increment (dP/dtmax) and end-diastolic volume (EDV) relationship. The relation between dP/dtmax and EDV in 1 representative rat from the levosimendan- and epinephrine-treated groups is shown. Note that the slope values were higher in levosimendan-treated than in epinephrine-treated rats, suggesting that systolic performance is improved after levosimendan infusion (A). Maximal slope of the systolic pressure increment (dP/dtmax) at baseline normothermia and after hypothermia–rewarming is shown in the control group (black bar), epinephrine group (gray bar), and levosimendan group (white bar). ∗P < .05 versus control; °P < .05 versus epinephrine (B). C and D, Preload recruitable stroke work (PRSW). The relation between stroke work and EDV in 1 representative rat from epinephrine and levosimendan group is shown. Note that slope values were higher in levosimendan rats than in epinephrine rats, suggesting that systolic performance is augmented in levosimendan (C). PRSW is the slope value of the relationship between stroke work and end-diastolic volume (EDV) in the groups of control, levosimendan, and epinephrine. ∗P < .05 versus control; °P < .05 versus epinephrine (D). The Journal of Thoracic and Cardiovascular Surgery 2012 143, 209-214DOI: (10.1016/j.jtcvs.2011.09.020) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Indexes of left ventricular (LV) relaxation. Maximal slope of the LV diastolic pressure decrement (dP/dtmin) and time constant of LV pressure decay (Tau) at baseline normothermia and after hypothermia–rewarming in control group (black bar), epinephrine group (gray bar), and levosimendan group (white bar). ∗P < .05 versus control; °P < .05 versus epinephrine. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 209-214DOI: (10.1016/j.jtcvs.2011.09.020) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Lactate plasma levels after rewarming in the 3 groups. °P < .05 versus epinephrine. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 209-214DOI: (10.1016/j.jtcvs.2011.09.020) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions