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

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• 作者：Alessio Rungatscher ; MD ; PhD ; ^{alessio.rungatscher@univr.it} ; Daniele Linardi ; MD ; Maddalena Tessari ; MSc ; Tiziano Menon ; MSc ; Giovanni Battista Luciani ; MD ; Alessandro Mazzucco ; MD ; Giuseppe Faggian ; MD
• 关键词：9 ; 16 ; 17 ; 27
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：January, 2012
• 年：2012
• 卷：143
• 期：1
• 页码：209-214
• 全文大小：696 K

文摘

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Objective

To investigate effects of epinephrine and levosimendan on cardiac function after rewarming from deep hypothermia.

Methods

Forty-five male Wistar rats (400-500 g) underwent cardiopulmonary bypass and were cooled to a core temperature of 13¡ãC to 15¡ãC within 30 minutes. After 15 minutes of deep hypothermic circulatory arrest, they were randomly assigned to treatment with levosimendan (12 ¦Ìg/kg; infusion of 0.2 ¦Ìg ¡¤ kg^?1 ¡¤ min^?1) (n?=?15) or epinephrine (0.1 ¦Ìg/kg; infusion of 0.1 ¦Ìg ¡¤ kg^?1 ¡¤ min^?1) (n?=?15) or saline as control (n?=?10). The rewarming lasted 60 minutes. Systolic and diastolic function was evaluated at different preloads with a conductance catheter, including the slope of the end-systolic pressure-volume relation (ESPVR) and end-diastolic pressure-volume relationship (EDPVR), preload recruitable stroke work, first derivative of left ventricular pressure (+dP/dt), and its relation to end-diastolic volume, as well as the time constant of left ventricular relaxation (Tau) and maximal slope of the diastolic pressure decrement (?dP/dt). Plasma lactate levels were collected.

Results

Stroke volume, ejection fraction and +dP/dt were significantly higher in the levosimendan-treated group than in the epinephrine group. The slope values of preload recruitable stroke work, ESPVR, and the relation of +dP/dt to end-diastolic volume were significantly higher, indicating a better contractility and increased systolic function. ?dP/dt was significantly higher in the levosimendan group (3468 ¡À 320 vs 1103 ¡À 101 mm Hg/s; P?<?.01). Left ventricular stiffness expressed by EDPVR and relaxation (Tau) were significantly improved in levosimendan-treated group. Plasma lactated concentrations were lower in levosimendan group (2.03 ¡À 1.27 vs 4.64 ¡À 1.02; P?<?.05).

Conclusions

Levosimendan has better inotropic and lusitropic effects than epinephrine during rewarming from deep hypothermic circulatory arrest with cardiopulmonary bypass.