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Neurohormonal effect of enhanced external counterpulsation in patients with acute myocardial infarction
The 3rd Annual Scientific Meeting
P-65
•
JHFS
69
P-66
AN OXYGEN FREE RADICAL SCAVENGER TIRON IMPROVES CORONARY ENDOTHELIAL DYSFUNCTION IN A CANINE MODEL OF TACHYCARDIA-INDUCED HEART FAILURE
THE EFFECT OF NIPPV ON ACUTE HEART FAILURE.
Kenichi Arimura, Kensuke Egashira, Rye Nakamura, Yoji Machida, Akira Takeshita Research institute of Angiocardiology, Kyushu University, Fukuoka 812-8582, Japan
Eiichi Tajid, Yutaka Furuta
Kazuyuki Kobayashi, Semi Satomi,Tomohiko Shirotani, Yoshihiro Ikeda, Tatsuya Kuniyoshi, Makoto Nakatani,
Recent evidence suggest that oxygen free radical (OFR) formation is increased in heart failure (HF), which raises the possibility that enhanced inactivation of endothelium-derived nitric oxide (NO) by OFR may be a cause of endothelial dysfunction in HF. To test this hypothesis, we examined whether an antioxidant treatment improves endothelial dysfunction in HF. A canine model of HF was produced by chronic rapid ventricular pacing for 4 weeks. Under anesthetized open-chest condition, we measured coronary blood flow at the left anterior descending coronary artery in HF dogs and control dogs. Changes in coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine (Ach) and endothelium-independent vasodilator sodium nitroprusside (SNP) were determined before and after an OFR scavenger tiron, and after a NO synthesis inhibitor NG-monomethyI-L-arginine (L-NMMA). Ach-induced vasodilation was less and OFR formation in coronary arterial and myocardial tissues was greater in HF dogs than in controls. Intracoronary infusion of tiron inhibited OFR formation and improved Ach-induced vasodilation in HF dogs but not in controls. L-NMMA diminished the beneficial effect of tiron on Ach-induced vasodilation in HF dogs. SNP-induced endcthelium-independent vasodilation was similar between control and HF dogs, and no change in its response was noted by tiron or tiron plus L-NMMA in either group. In summary, antioxidant treatment with tiron improved coronary endothelium-dependent vasodilation by increasing NOmediated vasodilation in tachycardia-induced HF. Thus, coronary endothelial dysfunction in HF may be at least in part due to increased inactivation of NO by OFR.
P-67 NEUROHORMONAL EFFECT COUNTERPULSATION IN MYOCARDIAL INFARCTION
Kasai Municipal Hospital, Hyogo, Japan We will report the experience of using Non-lnvasive Positive Pressure Ventilation (NIPPV) for the patient with acute heart failure. Twelve patients with acute heart failure due to AMI (n=8), angina with OMI (n=2) and hypertension (n=2) were subjected. We introduced NIPPV to the patients suffered from hypoxemia (O2Saturation <90%) under facial masked oxygenation (5 L/min.). In alt cases, NIPPY could be introduced and hypoxemia was improved immediately after that. Seven patients could be weaned from NIPPV in 48 hours and discharged hospital on walking. But, 3 patients could not be weaned from NIPPV and had to be intubated, because their basal disease worsened. Two patients with AMI died from arrhythmia under NIPPV. There was no difference in blood gas change after NIPPV and age The prognosis of subjects were depended on their basal disease. While, in Swan-Ganz catheter examination, NIPPV did not influence hemodynamics. We consider that NIPPV is effective to control hypoxemia in patients with acute heart failure, and that we had better to try to use NIPPV before intubation.
P-68 OF ENHANCED EXTERNAL P A T I E N T S WITH A C U T E
Isao Taguchi, Kenichi Ogawa, Akitugu Oida, Hideyo Kuga, Hidehiko Suzuki, Ichiro Nagao, Noboru Kaneko, Hideaki Sakio* Department of Cardiology and Pneurnology, Intensive Care Unit*, Dokkyo University School of Medicine, Tochigi 321-0293, Japan Enhanced external counterpulsation (EECP) has been postulated to have hemodynamic effects similar to those of Intraaortic Balloon Pumping (IABP) with benefits to patients with coronary artery disease. We compared hemodynamic effects of EECP with those of IABP in patients with acute myocardial infarction and balloon angioplasty and reported the hemodynamic effect of EECP was similar to that of IABP in diastolic enhancement. However, right atrial pressure (RAP) and pulmonary wedge >ressure increased during EECP as well as cardiac index in contrast to IABP. In this paper, we measured concentrations of adrenaline, noradrenaline, dopamine, atrial and brain natriuretic peptide (ANP, BNP) in peripheral blood of the same 33 patients i who were subjected by former hemodynamic study, and compared the neurohormonal effect of EECP with that of IABP. As shown in the table, neurohormonal factors did not change except for a significant increase in ANP with raised RAP caused by increase in venous return during EECP. Changes In Neurohormonal Factors (mean+SD, percent of control) 60 mina~erstart 60 min posttreatment EECP IABP EECP iABP adrenaline 113-+35 124+61 98+41 127-+37 noradrenaline 105-+14 104-+11 120-+20 116-+21 dopamine 102~21 135-+48 103+33 164+40 ANP 124-+36* 105-+14 65-+23 83-+27 BNP 102-+8 101+7 98+11 94+16 "=p<0.05 vs. control
Utility of concurrent treatment of P C P S and ~urification method to severe cardiogenic shock.
blood
KOUJI SEIMIYA, KEIJI TANAKA, JYUNN TANABE, HIYOYUK! MATSUDA, TAKAHIRO IMAIZUMI ICU & CCU; Nippon Medical School, Chiba Hokusoh Hospital, Chiba, 270-1613, Japan The utility of the concurrent treatment of Percutaneous Cardioputmonary Suppport System (PCPS) and Blood Purification Method (BPM) to extremely severe cardiogenic shock was evaluated. Subjects :31 cases with extremely severe cardiogenic shock ( udne volume 15ml/hr or less and systolic blood pressure 70mmHg or less ) who treated with a large amount of catecholamines, IABP and PCPS were investigatad. In 12 cases of them, BPM (CHF/CHDF) was performed together. To operate PCPS end BPM with one system, we built in the blood purification system the PCPS circuit. Results: 22 cases (71.0%) of 31 cases treated with PCPS recovered from cardiogenic shock (recovered group). Afterwards, 13 cases (59.1%) were able to discontinue PCPS (effective group). However, PCPS was not to be discontinued in 9 cases (dependent group). Only four cases (18.2%) survived (survived group). PCPS was invalid to 9 cases (29.0%).The BPM was performed to 12 cases (38.7%) V~len the effect of PCPS was judged in these 12 cases, all cases were included in the recovered group ; 8 cases (61.5%) in the effective group and 4 cases (44.4%) in the dependent group. There were few cases for which BPM was not necassan/from beginning in the survived group. Therefore, BPM was performed only 25.0% of the survived group. This method was useful for the removal of the contrast media after cardiac catheterization and the prevention of MOF. There were some cases of whom the improvement of hemodynamics by correcting of the acidosis and removing chemical mediators had been expected, if the BPM was used at the early stage in the ineffective group. Condu$1on:,lt is concluded that the combination of P C P S and B P M is useful for the treatment of severe cardiogenic shock.
P-65
•
JHFS
69
P-66
AN OXYGEN FREE RADICAL SCAVENGER TIRON IMPROVES CORONARY ENDOTHELIAL DYSFUNCTION IN A CANINE MODEL OF TACHYCARDIA-INDUCED HEART FAILURE
THE EFFECT OF NIPPV ON ACUTE HEART FAILURE.
Kenichi Arimura, Kensuke Egashira, Rye Nakamura, Yoji Machida, Akira Takeshita Research institute of Angiocardiology, Kyushu University, Fukuoka 812-8582, Japan
Eiichi Tajid, Yutaka Furuta
Kazuyuki Kobayashi, Semi Satomi,Tomohiko Shirotani, Yoshihiro Ikeda, Tatsuya Kuniyoshi, Makoto Nakatani,
Recent evidence suggest that oxygen free radical (OFR) formation is increased in heart failure (HF), which raises the possibility that enhanced inactivation of endothelium-derived nitric oxide (NO) by OFR may be a cause of endothelial dysfunction in HF. To test this hypothesis, we examined whether an antioxidant treatment improves endothelial dysfunction in HF. A canine model of HF was produced by chronic rapid ventricular pacing for 4 weeks. Under anesthetized open-chest condition, we measured coronary blood flow at the left anterior descending coronary artery in HF dogs and control dogs. Changes in coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine (Ach) and endothelium-independent vasodilator sodium nitroprusside (SNP) were determined before and after an OFR scavenger tiron, and after a NO synthesis inhibitor NG-monomethyI-L-arginine (L-NMMA). Ach-induced vasodilation was less and OFR formation in coronary arterial and myocardial tissues was greater in HF dogs than in controls. Intracoronary infusion of tiron inhibited OFR formation and improved Ach-induced vasodilation in HF dogs but not in controls. L-NMMA diminished the beneficial effect of tiron on Ach-induced vasodilation in HF dogs. SNP-induced endcthelium-independent vasodilation was similar between control and HF dogs, and no change in its response was noted by tiron or tiron plus L-NMMA in either group. In summary, antioxidant treatment with tiron improved coronary endothelium-dependent vasodilation by increasing NOmediated vasodilation in tachycardia-induced HF. Thus, coronary endothelial dysfunction in HF may be at least in part due to increased inactivation of NO by OFR.
P-67 NEUROHORMONAL EFFECT COUNTERPULSATION IN MYOCARDIAL INFARCTION
Kasai Municipal Hospital, Hyogo, Japan We will report the experience of using Non-lnvasive Positive Pressure Ventilation (NIPPV) for the patient with acute heart failure. Twelve patients with acute heart failure due to AMI (n=8), angina with OMI (n=2) and hypertension (n=2) were subjected. We introduced NIPPV to the patients suffered from hypoxemia (O2Saturation <90%) under facial masked oxygenation (5 L/min.). In alt cases, NIPPY could be introduced and hypoxemia was improved immediately after that. Seven patients could be weaned from NIPPV in 48 hours and discharged hospital on walking. But, 3 patients could not be weaned from NIPPV and had to be intubated, because their basal disease worsened. Two patients with AMI died from arrhythmia under NIPPV. There was no difference in blood gas change after NIPPV and age The prognosis of subjects were depended on their basal disease. While, in Swan-Ganz catheter examination, NIPPV did not influence hemodynamics. We consider that NIPPV is effective to control hypoxemia in patients with acute heart failure, and that we had better to try to use NIPPV before intubation.
P-68 OF ENHANCED EXTERNAL P A T I E N T S WITH A C U T E
Isao Taguchi, Kenichi Ogawa, Akitugu Oida, Hideyo Kuga, Hidehiko Suzuki, Ichiro Nagao, Noboru Kaneko, Hideaki Sakio* Department of Cardiology and Pneurnology, Intensive Care Unit*, Dokkyo University School of Medicine, Tochigi 321-0293, Japan Enhanced external counterpulsation (EECP) has been postulated to have hemodynamic effects similar to those of Intraaortic Balloon Pumping (IABP) with benefits to patients with coronary artery disease. We compared hemodynamic effects of EECP with those of IABP in patients with acute myocardial infarction and balloon angioplasty and reported the hemodynamic effect of EECP was similar to that of IABP in diastolic enhancement. However, right atrial pressure (RAP) and pulmonary wedge >ressure increased during EECP as well as cardiac index in contrast to IABP. In this paper, we measured concentrations of adrenaline, noradrenaline, dopamine, atrial and brain natriuretic peptide (ANP, BNP) in peripheral blood of the same 33 patients i who were subjected by former hemodynamic study, and compared the neurohormonal effect of EECP with that of IABP. As shown in the table, neurohormonal factors did not change except for a significant increase in ANP with raised RAP caused by increase in venous return during EECP. Changes In Neurohormonal Factors (mean+SD, percent of control) 60 mina~erstart 60 min posttreatment EECP IABP EECP iABP adrenaline 113-+35 124+61 98+41 127-+37 noradrenaline 105-+14 104-+11 120-+20 116-+21 dopamine 102~21 135-+48 103+33 164+40 ANP 124-+36* 105-+14 65-+23 83-+27 BNP 102-+8 101+7 98+11 94+16 "=p<0.05 vs. control
Utility of concurrent treatment of P C P S and ~urification method to severe cardiogenic shock.
blood
KOUJI SEIMIYA, KEIJI TANAKA, JYUNN TANABE, HIYOYUK! MATSUDA, TAKAHIRO IMAIZUMI ICU & CCU; Nippon Medical School, Chiba Hokusoh Hospital, Chiba, 270-1613, Japan The utility of the concurrent treatment of Percutaneous Cardioputmonary Suppport System (PCPS) and Blood Purification Method (BPM) to extremely severe cardiogenic shock was evaluated. Subjects :31 cases with extremely severe cardiogenic shock ( udne volume 15ml/hr or less and systolic blood pressure 70mmHg or less ) who treated with a large amount of catecholamines, IABP and PCPS were investigatad. In 12 cases of them, BPM (CHF/CHDF) was performed together. To operate PCPS end BPM with one system, we built in the blood purification system the PCPS circuit. Results: 22 cases (71.0%) of 31 cases treated with PCPS recovered from cardiogenic shock (recovered group). Afterwards, 13 cases (59.1%) were able to discontinue PCPS (effective group). However, PCPS was not to be discontinued in 9 cases (dependent group). Only four cases (18.2%) survived (survived group). PCPS was invalid to 9 cases (29.0%).The BPM was performed to 12 cases (38.7%) V~len the effect of PCPS was judged in these 12 cases, all cases were included in the recovered group ; 8 cases (61.5%) in the effective group and 4 cases (44.4%) in the dependent group. There were few cases for which BPM was not necassan/from beginning in the survived group. Therefore, BPM was performed only 25.0% of the survived group. This method was useful for the removal of the contrast media after cardiac catheterization and the prevention of MOF. There were some cases of whom the improvement of hemodynamics by correcting of the acidosis and removing chemical mediators had been expected, if the BPM was used at the early stage in the ineffective group. Condu$1on:,lt is concluded that the combination of P C P S and B P M is useful for the treatment of severe cardiogenic shock.