Journal of Cardiac Failure
Volume 14, Issue 5 , Pages 400-406, June 2008

Inotropic Agents Improve the Peripheral Microcirculation of Patients With End-Stage Chronic Heart Failure

  • Serafim Nanas, MD

      Affiliations

    • Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, “Evgenidio” Hospital
    • Corresponding Author InformationReprint requests: Serafim Nanas, MD, Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, “Evgenidio Hospital,” National and Kapodestrian University of Athens 20, Papadiamantopoulou St, Athens, 11528, Greece.
    • ,
  • Vasiliki Gerovasili, MD

      Affiliations

    • Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, “Evgenidio” Hospital
    • ,
  • Stavros Dimopoulos, MD

      Affiliations

    • Clinical Therapeutics Department, “Alexandra” Hospital, National and Kapodestrian University of Athens, Greece
    • ,
  • Charalampos Pierrakos, MD

      Affiliations

    • Clinical Therapeutics Department, “Alexandra” Hospital, National and Kapodestrian University of Athens, Greece
    • ,
  • Soultana Kourtidou, MD

      Affiliations

    • Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, “Evgenidio” Hospital
    • ,
  • Elissavet Kaldara, MD

      Affiliations

    • Clinical Therapeutics Department, “Alexandra” Hospital, National and Kapodestrian University of Athens, Greece
    • ,
  • Serafim Sarafoglou, MD

      Affiliations

    • Clinical Therapeutics Department, “Alexandra” Hospital, National and Kapodestrian University of Athens, Greece
    • ,
  • John Venetsanakos, MD

      Affiliations

    • Clinical Therapeutics Department, “Alexandra” Hospital, National and Kapodestrian University of Athens, Greece
    • ,
  • Charis Roussos, MD, MRCP, PhD

      Affiliations

    • Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, “Evgenidio” Hospital
    • ,
  • John Nanas, MD, PhD

      Affiliations

    • Clinical Therapeutics Department, “Alexandra” Hospital, National and Kapodestrian University of Athens, Greece
    • ,
  • Maria Anastasiou-Nana, MD

      Affiliations

    • Clinical Therapeutics Department, “Alexandra” Hospital, National and Kapodestrian University of Athens, Greece

Received 1 November 2006; received in revised form 23 January 2008; accepted 1 February 2008.

Abstract 

Background

Skeletal muscle microcirculation impairment in patients with chronic heart failure (CHF) seems to correlate with disease severity. We evaluated the microcirculation by near-infrared spectroscopy (NIRS) occlusion technique before and after inotropic infusion.

Methods

We evaluated 25 patients with stable CHF, 30 patients with end-stage CHF (ESCHF) receiving treatment with intermittent infusion of inotropic agents, and 12 healthy subjects. Thenar muscle tissue oxygen saturation (StO2%) was measured noninvasively by NIRS before, during, and after 3-minute occlusion of the brachial artery (occlusion technique) in all subjects and in patients with ESCHF before and after 6 hours of inotropic infusion (dobutamine and/or levosimendan) or placebo (N = 5).

Results

Patients with ESCHF or CHF presented significantly lower StO2% than healthy subjects (74.5% ± 7%, 78.6% ± 6%, and 85% ± 5%, respectively; P = .0001), lower oxygen consumption rate during occlusion (24.6% ± 8%/min, 28.6% ± 10%/min, and 38.1% ± 11.1%/min, respectively; P = .001), and lower reperfusion rate (327% ± 141%/min, 410% ± 106%/min, and 480% ± 133%/min, respectively; P = .002). After 6 hours of inotropic infusion, patients with ESCHF showed significantly increased StO2% (74.5% ± 7% to 82% ± 9%, P = .001), oxygen consumption rate (24.6% ± 8%/min to 29.3% ± 8%/min, P = .009), and reperfusion rate (327% ± 141%/min to 467% ± 151%/min, P = .001). No statistical difference was noted in the placebo group.

Conclusion

Peripheral muscle microcirculation as assessed by NIRS is impaired in patients with CHF. This impairment is partially reversed by infusion of inotropic agents in patients with ESCHF.

Key Words: Severe heart failure, near infra-red spectroscopy, microcirculation, inotropes

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 This study was partly funded by grant from the Special Account for Research Grants of the National and Kapodistrian University of Athens, Greece, and by the Thorax Foundation.

PII: S1071-9164(08)00066-3

doi:10.1016/j.cardfail.2008.02.001

Journal of Cardiac Failure
Volume 14, Issue 5 , Pages 400-406, June 2008

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