Abstract
Purpose
To evaluate the effect of milrinone on diastolic function during coronary artery bypass grafting surgery (CABG).
Methods
Fifty patients undergoing CABG were randomized to receive a bolus and infusion of milrinone or placebo before cardiopulmonary bypass (CPB) until skin closure. Hemodynamic and transesophageal echocardiographic measurements of systolic and diastolic function were obtained. Pulsed wave Doppler measurements of the early (E wave) and atrial components (A wave) of the transmitral (TMF) and transtricuspid (TTF) flows, and systolic (S wave), diastolic (D wave) and atrial components (Ar) of the pulmonary (PVF) and hepatic venous blood flow (HVF) velocities were performed. Early and atrial components of the mitral (Em and Am waves) and tricuspid annulus velocities (Et and At waves) were assessed by tissue Doppler imaging (TDI). Assessment of diastolic dysfunction was graded from normal to severe using a scale score.
Results
Cardiac index and heart rate were higher in the milrinone group compared to placebo after the administration of study drug (2.8 ± 0.6 vs2.1 ± 0.5 L·min-1m-2) (P < 0.0001 ) and (67 ± 8 vs 60 ± 12 beats·min-1) (P < 0.05) respectively. There were no changes in left and right ventricular diastolic dysfunction scores between study groups. Higher PVF S wave, HVF S wave, TTF A wave and At measured by TDI in the milrinone group compared with placebo suggested an improvement in ventricular systolic and atrial contraction.
Conclusion
Distinct from its effects on systolic function, milrinone administered before CPB is not with associated improved biventricular diastolic function in patients undergoing CABG.
Objectif
Evaluer l’effet de la milrinone sur la fonction diastolique durant un pontage aortocoronarien (PAC).
Méthode
Cinquante patients subissant un PAC ont été randomisés à recevoir soit une dose bolus et une perfusion de milrinone, soit un placebo avant la circulation extracorporelle (CEC) jusqu’à fermeture de la peau. Les mesures hémodynamiques et échocardiographiques transoesophagiennes des fonctions systolique et diastolique ont été obtenues. Les mesures Doppler pulsées des composantes précoces (onde E) et auriculaires (onde A) des débits transmitral (TMF) et transtricuspide (TTF), et les composantes systolique (onde S) diastolique (onde D) et auriculaires (Ar) des vélocités du débit sanguin veineux pulmonaire (PVF) et hépatique (HVF) ont été prises. Les composantes précoces et auriculaires des vélocités de l’anneau mitral (ondes Em et Am) et de l’anneau tricuspide (ondes Et et At) ont été mesurées par Doppler tissulaire (TDI). La dysfonction diastolique a été gradée de normale à sévère sur une échelle de scores.
Résultats
L’index cardiaque et la fréquence cardiaque ont été plus élevés dans le groupe milrinone comparé au groupe placebo après la prise du médicament à l’étude (2,8 ± 0,6 vs 2,1 ± 0,5 L·min-1m-2) (P < 0,0001) et (67 ± 8 vs 60 ± 12 battements·min-1) (P < 0,05), respectivement. Il n’y a pas eu de changement dans les résultats de scores de dysfonction diastolique des ventricules gauche et droit entre les groupes d’étude. On a mesuré par TDI des ondes PVF S, HVF S et TTFA ainsi qu’un At plus élevés dans le groupe milrinone que dans le groupe placebo, ce qui suggère une amélioration de la contraction ventriculaire et auriculaire.
Conclusion
En dehors de ses effets sur la fonction systolique, la milrinone administrée avant la CEC n’est pas associée à une meilleure fonction diastolique biventriculaire chez les patients subissant un PAC.
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Abbreviations
- A:
-
atrial filling A-wave velocity
- Am:
-
late mitral annular velocity
- Ar:
-
reversed atrial flow
- At:
-
atrial filling tricuspid annular velocity
- CABG:
-
coronary artery bypass grafting
- CPB:
-
cardiopulmonary bypass
- D:
-
diastolic D-wave velocity
- DT:
-
E-wave deceleration time
- E:
-
early mitral filling E-wave velocity
- Em:
-
early mitral annular velocity
- Et:
-
early filling tricuspid annular velocity
- EDA:
-
end-diastolic area
- ESA:
-
end-systolic area
- FAC:
-
fractional area change
- HVF:
-
hepatic venous flow
- IVRT:
-
isovolumic relaxation time
- LAD:
-
left atrial diameter
- LVDD:
-
left ventricular diastolic dysfunction
- LVEF:
-
left ventricular ejection fraction
- MAV:
-
mitral annular velocity
- PVF:
-
pulmonary venous flow
- PW:
-
pulsed wave
- RAD:
-
right atrial diameter
- RVDD:
-
right ventricular diastolic dysfunction
- S:
-
systolic S-wave velocity
- Sm:
-
systolic mitral annular velocity
- St:
-
systolic tricuspid annular velocity
- TAV:
-
tricuspid annular velocity
- TDI:
-
tissue Doppler imaging
- TMF:
-
transmitral flow
- TTF:
-
transtricuspid flow
- Vp:
-
colour M mode propagation velocity
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Supported by Dr. Earl Wynands Research Award in Cardiovascular Anesthesia, 2001.
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Couture, P., Denault, A.Y., Pellerin, M. et al. Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery. Can J Anesth 54, 509–522 (2007). https://doi.org/10.1007/BF03022314
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DOI: https://doi.org/10.1007/BF03022314