Clinical InvestigationInotropic Agents Improve the Peripheral Microcirculation of Patients With End-Stage Chronic Heart Failure
Section snippets
Patients
The study group consisted of 55 patients with CHF (48 male/7 female; mean age, 56 ± 13 years) and a group of 12 healthy subjects (8 male/4 female). Twenty-five of the patients with CHF had a diagnosis of stable, mild to moderate CHF (21 male/4 female; mean age, 54 ± 12 years), and 30 patients with CHF (27 male/3 female; mean age, 58 ± 14 years) were diagnosed with ESCHF refractory to standard optimal drug therapy, including digoxin, enalapril, spironolactone, furosemide, and oral amiodarone.
Results
Patients with ESCHF and CHF presented significantly lower StO2 than healthy subjects (74.5% ± 7%, 78.6% ± 6%, and 85% ± 5%, respectively; P = .0001) and lower oxygen consumption rate during the occlusion of the brachial artery (24.6% ± 8%/min, 28.6% ± 10%/min, and 38.1% ± 11.1%/min, respectively; P = .001) (Figure 1; Table 2). The reperfusion rate differed significantly among patients with ESCHF, patients with CHF, and healthy subjects (327% ± 141%/min, 410% ± 106%/min, and 480% ± 133%/min,
Discussion
This study shows that patients with CHF are characterized by marked abnormalities in skeletal muscle tissue microcirculation as assessed by the NIRS occlusion technique, which can be partly reversed by infusion of inotropic agents.
Specifically, resting skeletal muscle tissue oxygenation was lower in patients with CHF, and this reduction was more prominent in patients with ESCHF than in healthy subjects. In addition, the brachial artery occlusion led to a slower oxygen consumption rate and
Limitations
A limitation of our study was the relatively small number of patients with ESCHF who participated. Patients with ESCHF included in the study were receiving 3 different inotropic regimens (dobutamine and/or levosimendan), making comparison of the 3 groups difficult because of the small number of patients. However, all patients showed improved tissue oxygenation after infusion of inotropic agents.
Conclusions
Our study has shown that peripheral muscle microcirculation, as assessed with the NIRS occlusion technique, is impaired in patients with CHF and that the degree of microcirculatory dysfunction is associated with disease severity. This impairment seems to be partly reversed with infusion of inotropic agents. The NIRS occlusion technique might be a useful clinical tool in the evaluation of the peripheral microcirculation in patients with CHF. Further studies are needed to evaluate the long-term
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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.