Improvement in Myocardial Function and Coronary Blood Flow in Ischemic Myocardium after Mannitol
Key result
Mannitol infusion during experimental myocardial ischemia in dogs significantly increased collateral coronary blood flow by 9.5 cc/min per 100 g LV and improved ventricular function.
Why the study?
Does mannitol improve myocardial function and coronary blood flow during myocardial ischemia in a canine model?
Population
46 anesthetized dogs with myocardial ischemia produced by temporary ligation of the proximal or mid-left…
Comparison
Mannitol infused into the aortic roots before… vs Ischemic state without mannitol
Design
Preclinical
Authors
Discussion
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Member takes
Implication
Does not support mannitol use in human ischemia; leaves open translation of collateral flow effects to clinical trials.
Structured PICO
Does mannitol improve myocardial function and coronary blood flow during myocardial ischemia in a canine model?
P
Population
46 adult mongrel dogs undergoing experimental myocardial ischemia via left anterior descending coronary artery occlusion.
I
Intervention
Mannitol infused into the aortic roots before and during ischemia
C
Comparator
Ischemic state without mannitol (baseline comparison)
O
Outcome
Myocardial function (ventricular function curves), S-T segment elevation, total coronary blood flow, and collateral coronary blood flowsurrogate
Main Result
Mean Difference: 9.5
Absolute Event Rate: 19.6% vs 10.1%
p-value: p=<0.005
In a canine model of myocardial ischemia, hyperosmolality induced by mannitol infusion improved myocardial function, reduced ischemic ECG changes, and increased both total and collateral coronary blood flow.
Limitations
- Animal model (dogs) may not directly translate to human clinical practice
- Exact method and circumstances for clinical administration in patients remain unknown
- Unclear if inotropic properties are independent of blood flow effects in a hypoxic environment
Cite This Study
Willerson et al. (1972) studied Myocardial ischemia (n=46). Mannitol vs. Ischemia without mannitol (control ischemic periods) was evaluated on Collateral coronary blood flow during ischemia (MD 9.5 cc/min per 100 g LV, p=<0.005). Mannitol infusion during experimental myocardial ischemia in dogs significantly increased collateral coronary blood flow by 9.5 cc/min per 100 g LV and improved ventricular function.