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Background: Levosimendan (LEVO), a new inodilator, improves hemodynamic function in patients with decompensated heart failure and preserved arterial blood pressure. Data on its use in patients with cardiogenic shock (CS) are scarce. The present study was undertaken to evaluate the hemodynamic effects of supplemental therapy with levosimendan (LEVO) in acute myocardial infarction (MI) and refractory cardiogenic shock (CS). Methods: In 25 patients presenting in CS after acute MI, LEVO was administered for 24 h in doses ranging between 0.05 and 0.20 µg/kg/min, as tolerated, preceded by 6-µg/kg over 10 min, in addition to catecholamines. Hemodynamic measurements were made before and 24 h after initiation of the LEVO infusion. Results: Hemodynamic improvement was limited to 13 patients with systemic vascular resistances (SVR) ≥18 W. LEVO increased the cardiac index from 1.5±0.3 l/min/m2 to 2.1±0.4 l/min/m2 (P = 0.002) and cardiac power from 0.462±0.164 W to 0.645±0.179 W (P = 0.022), and decreased SVR from 23±5 to 21±6.7 Wood units (P = 0.001) and pulmonary capillary wedge pressure from 24±9 mmHg to 16±11 mmHg (P = 0.059). No hemodynamic improvement was observed during LEVO administration in 12 patients with SVR < 18 W. Conclusion: The hemodynamic benefit conferred by LEVO added to catecholamines in patients with CS after acute MI was limited to patients with high SVR. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patients with chronic heart failure (CHF) present with exercise-induced hyperpnea, but its pathophysiological mechanism has not been thoroughly investigated. We aimed to determine the relationship between exercise-induced hyperpnea, resting haemodynamic measurements and the validity of ventilatory response (V E/V CO2 slope) as a mortality predictor in CHF patients. Methods: Ninety-eight CHF patients (90M/8F) underwent a symptom-limited treadmill cardiopulmonary exercise test (CPET). Right heart catheterization and radionuclide ventriculography were performed within 72 h of CPET. Results: Twenty-seven patients died from cardiac causes during 20±6 months follow-up. Non-survivors had a lower peak oxygen consumption (V O2p), (16.5±4.9 vs. 20.2±6.1, ml/kg/min, p =0.003), a steeper V E/V CO2 slope (34.8±8.3 vs. 28.9±4.8, p <0.001) and a higher pulmonary capillary wedge pressure (PCWP) (19.5±8.6 vs. 11.7±6.5 mm Hg, p =0.008) than survivors. By multivariate survival analysis, the V E/V CO2 slope as a continuous variable was an independent prognostic factor (χ 2: 8.5, relative risk: 1.1, 95% CI: 1.03–1.18, p =0.004). Overall mortality was 52% in patients with V E/V CO2 slope ≥34 and 18% in those with V E/V CO2 slope <34 (log rank: 18.5, p <0.001). In a subgroup of patients (V O2p: 10–18 ml/kg/min), V E/V CO2 slope was a significant predictor of mortality (relative risk: 6.2, 95% CI: 1.7–22.2, p =0.002). Patients with high V E/V CO2 slope had higher resting PCWP (19.9±9.1 vs. 11.3±5.7 mmHg, p <0.001) and V E/V CO2 slope correlated significantly with PCWP (r: 0.57, p <0.001). Conclusions: The V E/V CO2 slope, as an index of ventilatory response to exercise, improves the risk stratification of CHF patients. Interstitial pulmonary oedema may be a pathophysiological mechanism of inefficient ventilation during exercise in these patients. [Copyright &y& Elsevier]

To examine the effects of long-term intermittent dobutamine infusion, combined with oral amlodarone in patients with congestive heart failure (CHF) refractory to standard medical treatment. Kaplan-Meier survival analysis showed a 60% reduction in the risk of death from any cause in the group treated with the combination of dobutamine and amiodarone, compared with the group treated with placebo and amiodarone (hazard ratio, 0.403; 95% confidence interval, 0.164 to 0.992; p = 0.048). The 1-year and 2-year survival rates were 69% and 44%, respectively, in the dobutamine-treated group, vs 28% and 21%, respectively, in the placebo-treated group (p < 0.05 for both comparisons). Median survival times were 574 and 144 days, respectively, for groups 2 and 1. At 6 months, the New York Heart Association functional class was significantly improved in the patients who survived from both groups. Long-term intermittent dobutamine infusion combined with amiodarone added to the conventional drugs improved the survival of patients with advanced CHF that was refractory to conventional treatment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the hemodynamic effectiveness of a 30-ml stroke volume paraaortic counterpulsation device (PACD), presenting the advantages of ease of implantation and driving by a standard intraaortic balloon pump (IABP) console (Datascope 96, Data-scope Corp., Montvale, NJ, USA) to that of a 40-ml IABP, in the setting of experimental heart failure. In an acute heart failure model, the IABP was placed in the descending aorta and the PACD in the ascending aorta of eight pigs. Both devices were driven by the same system, and hemodynamic measurements were obtained with and without mechanical assistance. The two pumps significantly reduced the systolic and end-diastolic aortic pressures, but the PACD reduced the fatter more effectively (42.6 ± 18.1% vs 11.0 ± 9.9% p = 0.0001). Both pumps provided significant aortic diastolic augmentation, but the countorpulsation wave of the PACD was significantly greater (augmentation of 44.8 ± 22.2% vs 37.6 The purpose of this study was to compare the hemodynamic effectiveness of a 30-ml stroke volume paraaortic counterpulsation device (PACD), presenting the advantages of ease of implantation and driving by a standard intraaortic balloon pump (IABP) console (Datascope 96, Data-scope Corp., Montvale, NJ, USA) to that of a 40-ml IABP, in the setting of experimental heart failure. In an acute heart failure model, the IABP was placed in the descending aorta and the PACD in the ascending aorta of eight pigs. Both devices were driven by the same system, and hemodynamic measurements were obtained with and without mechanical assistance. The two pumps significantly reduced the systolic and end-diastolic aortic pressures, but the PACD reduced the fatter more effectively (42.6 ± 18.1% vs 11.0 ± 9.9% p = 0.0001). Both pumps provided significant aortic diastolic augmentation, but the countorpulsation wave of the PACD was significantly greater (augmentation of 44.8 ± 22.2% vs 37.6 ± 15.6%, p = 0.031). Both lowered the end-diastolic left ventricular pressure with a trend toward PACD superiority (24.2 ± 13.7% vs 19.7 ± 13.5%, p = 0.064). It is concluded that the PACD, even with smaller stroke volume, is more effective than the IABP. The simplicity of its implantation, together with the ability of the standard LABP consoles to control its function, make it a promising device for mechanical assistance of the failing heart. 15.6%, p = 0.031). Both lowered the end-diastolic left ventricular pressure with a trend toward PACD superiority (24.2 ± 13.7% vs 19.7 ± 13.5%, p = 0.064). It is concluded that the PACD, even with smaller stroke volume, is more effective than the IABP. The simplicity of its implantation, together with the ability of the standard LABP consoles to control its function, make it a promising device for mechanical assistance of the failing heart. [ABSTRACT FROM AUTHOR]

Study objective: To evaluate the effects of long-term intermittent dobutamine infusion (IDI) with concomitant administration of low-dose amiodarone in patients with congestive heart failure (CHF) refractory to standard medical treatment. Design: Prospective, interventional clinical trial. Setting: Inpatient and outpatient heart failure clinic in a university teaching hospital. Patients and interventions: Twenty-two patients with CHF refractory to standard treatment who could be weaned from dobutamine therapy after an initial 72-h infusion were included in this study. The first 11 patients (group 1) were treated with IDI, 10 µg/kg/min, as needed (mean, once every 16 days, lasting for 12 to 48 h); the next 11 patients (group 2) received oral amiodarone, 400 mg/d, and IDI, 10 µg/kg/min, for 8 h every 7 days. Measurement and results: There were no differences in baseline clinical, hemodynamic, and five biochemical characteristics between the two groups. The left ventricular ejection fraction was 13.5 ± 4.5% in group 1 vs 15.5 ± 4.9% in group 2 (mean ± SD; p = 0.451); mean pulmonary capillary wedge pressure was 31.3 ± 4.4 mm Hg vs 29.4 ± 3.3 mm Hg (p = 0.316); serum creatinine was 1.9 ± 0.4 mg/dL vs 1.6 ± 0.5 mg/dL (p = 0.19); and serum Na was 139.6 ± 6.2 mEq/L vs 138.4 ± 3.1 mEq/L (p = 0.569). At 12 months of follow-up, 1 of 11 patients (9%) was alive in group 1 vs 6 of 11 patients (55%) in group 2 (p = 0.011). Furthermore, in group 2, the functional status improved significantly within the first 3 months of treatment, from New York Heart Association functional class IV to 2.63 ± 0.5 (p = 0.0001). Conclusion: Long-term IDI in conjunction with amiodarone, added to conventional drugs, improved clinical status and survival of patients with severe CHF. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to the coronary blood flow and ventricular fibrillation threshold in beta-blocked dogs with stabilized hemodynamics. Several clinical trials have shown that long-term therapy with a beta adrenergic blocking drug after acute myocardial infarction can reduce overall mortality and particularly sudden cardiac death. Five healthy adult Mongrel dogs of either sex weighing between 20 and 25 kilograms were anesthetized with intravenous chloralose. This study examined the effects of timolol on vulnerability to ventricular fibrillation in comparison with LV function indices and coronary blood flow in a hemodynamically stabilized preparation. It appears that the antifibrillatory effect of beta-blockade with timolol is present despite depressed LV function.

p < 0.001), the tension time index (712 ± 381 versus 1333 ± 694, p < 0.01), and the double product (5629 ± 2574 versus 7440 ± 3294, p < 0.01) were significantly lower during assistance with the PACD than with the CBP. It was concluded that PACD is at least as effective as CBP for restoring hemodynamic status during acute experimental cardiogenic shock. Moreover, the PACD unloads the left ventricle more effectively than CBP, making it suitable for left ventricular mechanical support in cases with reversible myocardial damage. [ABSTRACT FROM AUTHOR]

Recainam hydrochloride is a newly synthesized propylurea compound demonstrating potent antidysrhythmic effects. Recainam was administered as a loading dose of 3 mg/kg/40 minutes followed by a continuous infusion of 0.9 mg/kg/hr for 23 hours and 20 minutes to ten patients with cardiac disease and frequent PVCs (more than 30/hr). A total of 15 plasma samples were drawn over 36 hours during and after the infusion. Plasma recainam concentration was determined by high performance liquid chromatography (HPLC). The mean (± SD) postload and 24-hour plasma concentrations were 5.19 ± 0.51 and 3.41 ± 0.71 μg/mL, respectively. The data were best described by a two-compartment model yielding the following mean (± SD) pharmacokinetic parameters: λ1 = 2.62 ± 0.68 hr−1, λ2 = 0.144 ± 0.014 hr−1, t1/2 λ2 = 4.84 ± 0.46 hr, CLT = 0.268 ± 0.057 L/hr/kg, CLR = 0.143 ± 0.052 L/kg/hr, CLNR = 0.125 ± 0.041 L/hr/kg, Vdss =1.3 ± 0.19 L/kg, and Vdλ2 = 1.9 ± 0.43 L/kg. There were no adverse reactions. Based on these data, recainam can be safely administered as a loading dose followed by a continuous infusion in patients with stable cardiac disease without significant ventricular dysfunction. [ABSTRACT FROM AUTHOR]

A 34-year old woman who used oral contraception presented with a history of substernal pain and dyspnea, beginning 2 weeks before her admission to our hospital and, finally, exertional syncope. Clinical and laboratory findings confirmed the diagnosis of pulmonary embolism. Besides the use of oral contraception, she was suffering from antiphospholipid syndrome. [ABSTRACT FROM AUTHOR]