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CLINICAL STUDY: HEART FAILURE

The effects of dobutamine on cardiac sympathetic activity in patients with congestive heart failure

^* Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada

Manuscript received July 31, 2001; revised manuscript received January 3, 2002, accepted January 18, 2002.

^* Reprint requests and correspondence: Dr. John D. Parker, Division of Cardiology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1609, Toronto, Ontario, Canada M5G 1X5.
jdp{at}inforamp.net

OBJECTIVES: The goal of this work was to study the effects of short-term infusion of dobutamine on efferent cardiac sympathetic activity.

BACKGROUND: Increased efferent cardiac sympathetic activity is associated with poor outcomes in the setting of congestive heart failure (CHF). Dobutamine is commonly used in the therapy of decompensated CHF. Dobutamine, through its effects on excitatory beta-receptors, may increase cardiac sympathetic activity.

METHODS: Seven patients with normal left ventricular (LV) function and 13 patients with CHF were studied. A radiotracer technique was used to measure cardiac norepinephrine spillover (CANESP) before and during an intravenous infusion of dobutamine titrated to increase the rate of rise in LV peak positive pressure (+dP/dt) by 40%.

RESULTS: Systemic arterial pulse pressure increased significantly in response to dobutamine in the normal LV function group (74 ± 3 mm Hg to 85 ± 3 mm Hg, p = 0.005) but remained unchanged in the CHF group. Dobutamine caused a significant decrease in LV end-diastolic pressure in the CHF group (14 ± 2 mm Hg to 11 ± 2 mm Hg, p = 0.02), an effect not observed in the normal LV group. In the normal LV function group, CANESP did not change in response to dobutamine (75 ± 22 pmol/min vs. 72 ± 22 pmol/min, p = NS). In contrast, dobutamine infusion was associated with a significant reduction in CANESP in patients with CHF (199 ± 43 pmol/min to 128 ± 30 pmol/min, p < 0.0009).

CONCLUSIONS: Dobutamine infusion caused a significant sympatholytic response in patients with CHF. This sympathetic withdrawal response is probably related to reduction of LV filling pressures and/or activation of ventricular mechanoreceptors with dobutamine infusion.

Abbreviations and Acronyms   CANESP   cardiac norepinephrine spillover   CHF   congestive heart failure   HPLC   high-performance liquid chromatography   LV   left ventricle/ventricular   +dP/dt   rate of rise in left ventricular peak positive pressure

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