Hemodynamic consequences of inotropic support with digoxin or amrinone in lambs with ventricular septal defect

ABSTRACT ABSTRACT: Inotropic support with digoxin is commonly used in patients with left ventricular volume overload due to ventricular septal defect (VSD). However, the hemodynamic

consequences of inotropic agents with VSD have not been experimentally explored. We studied two inotropic agents, digoxin and amrinone, in chronically instrumented lambs with left

ventricular volume overload due to a surgically created VSD. Intravenous digoxin (40 μg/kg) produced serum levels of 3.5 ± 0.9 ng/ml (mean ± SD) in seven lambs 60 min after administration,

reduced the heart rate by 16% (172 to 149 beats/min, _p_ < 0.05), increased the stroke volume 16% (29.8 to 34.5 ml/beat, _p_ < 0.05) but did not significantly alter the systemic flow

index (Qs), the pulmonary flow index (Qp), or the volume of left to right shunt (QL-R, 6.74 to 6.77 liter/min/m2). The mean left atrial pressure (LA) was unchanged (17.6 _versus_ 17.1 mm Hg)

following digoxin. Chronic digoxin use in four lambs for 4 days (25 ± 8 μg/kg/8 h) produced trough serum levels of 1.2 ± 0.2 ng/ml. There was no additional hemodynamic effect compared to

acute digoxin, the QP/QS ratio was unchanged (3.10 _versus_ 3.08) and evidence of left ventricular volume overload (LA – 14.0 _versus_ 13.4) was unchanged. Amrinone lowered the systemic

resistance index in a dose dependent fashion. The peak reduction of 20% (25.3 to 20.3 U/m2, _p_ < 0.01) occurred at 20 min after an intravenous (3 mg/kg) bolus in seven Iambs. The Qs

increased from 2.58 to 3.10 liter/min/m2 (_p_ < 0.01). The Qp was unchanged, thus the Qp/Qs ratio was lowered by 16% (_p_ < 0.05). Amrinone caused a 17% reduction in LA (17.9 to 14.9,

_p_ < 0.05) and increased the heart rate by 7%. The data indicate that the peripheral vascular effects of amrinone offer a hemodynamic advantage compared to acute digoxin. SIMILAR CONTENT

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ARTICLE PDF AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Pediatrics, Division of Cardiology, University of Utah College of Medicine and The Primary Children's Medical

Center, Salt Lake City, 84103, Utah Mark M Boucek, Richard Chang & David P Synhorst Authors * Mark M Boucek View author publications You can also search for this author inPubMed Google

Scholar * Richard Chang View author publications You can also search for this author inPubMed Google Scholar * David P Synhorst View author publications You can also search for this author

inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Boucek, M., Chang, R. & Synhorst, D. Hemodynamic Consequences of Inotropic

Support with Digoxin or Amrinone in Lambs with Ventricular Septal Defect. _Pediatr Res_ 19, 887–891 (1985). https://doi.org/10.1203/00006450-198509000-00002 Download citation * Received: 09

October 1984 * Accepted: 08 April 1985 * Issue Date: 01 September 1985 * DOI: https://doi.org/10.1203/00006450-198509000-00002 SHARE THIS ARTICLE Anyone you share the following link with

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