Key result
Insulin plus dopamine increases SV and CO versus dopamine alone in canine acute ischemic HF.
Why the study?
Does the combination of dopamine and insulin improve hemodynamics and metabolic profile in a canine model of acute ischemic heart failure?
Does the combination of dopamine and insulin improve hemodynamics and metabolic profile in a canine model of acute ischemic heart failure?
In a canine model of acute ischemic heart failure, combining insulin with dopamine improved cardiac output and shifted myocardial metabolism toward carbohydrates compared to dopamine alone.
Hypothesis-generating for insulin-dopamine in canine ischemic HF; prospective human trials needed before clinical consideration.
Acute ischemic heart failure was induced in eight dogs by coronary embolization. Severe depression of the left ventricular (LV) performance was evidenced. At 15 min after the embolization procedure, dopamine was infused at a dosage sufficient to increase the maximum rate of LV pressure rise (LVdP/dtmax) by approximately 50%. The significant improvement in cardiac performance was obtained at unaltered myocardial oxygen consumption (MVo2). Dopamine infusion was concluded, and after a stabilization period 300 IU of insulin was injected. This was followed by the infusion of glucose and potassium to maintain levels. Insulin significantly improved the performance of the failing left ventricle at unaltered MVo2, but to a lesser extent than did dopamine. Additional dopamine infusion further significantly improved cardiac performance. The net effect of insulin and dopamine in combination as compared with dopamine alone was a significantly greater increase in stroke volume and cardiac output due to a more pronounced decrease in total peripheral resistance. Dopamine increased arterial concentrations and myocardial uptake of free fatty acids (FFA). The net metabolic effect of insulin and dopamine in combination as compared with dopamine alone was a shift in myocardial substrate uptake from FFA to carbohydrates.
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Reikerås et al. (1986) studied Acute ischemic heart failure (n=8). Dopamine and insulin vs. Dopamine alone was evaluated on Hemodynamic and metabolic effects (cardiac performance, stroke volume, cardiac output, total peripheral resistance, myocardial substrate uptake). In dogs with acute ischemic heart failure, the combination of insulin and dopamine significantly increased stroke volume and cardiac output compared to dopamine alone.
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