Quantitative Transthoracic Echocardiography of the Response to Dobutamine in Cardiac Surgery Patients With Low Cardiac Output Syndrome.
OBJECTIVE
To quantify the acute effects of dobutamine in postoperative low cardiac output syndrome (LCOS) using transthoracic echocardiographic, hemodynamic, and blood biomarker monitoring and to assess its association with clinical outcomes.


DESIGN
Observational prospective study.


SETTING
Single university hospital.


PARTICIPANTS
Patients undergoing elective cardiac surgery.


INTERVENTIONS
None.


MEASUREMENTS AND MAIN RESULTS
Echocardiographic parameters, hemodynamic data, and plasma biomarkers were obtained before and early after inotrope initiation. The diagnostic value of transthoracic echocardiographic parameters and their association with clinical outcome were evaluated. Thirty-eight LCOS patients and 12 control patients were included. The left ventricular outflow tract velocity time integral was significantly lower in LCOS patients (11.75 v 19.08 cm; p < 0.001) and showed a marked improvement after dobutamine administration (∼37% increase). Dobutamine improved left and right ventricular function, increased mean arterial pressure and urine output, and lowered lactate levels. The duration of dobutamine support, but not in-hospital mortality, was associated with echocardiographic estimates of cardiac performance early after dobutamine initiation.


CONCLUSIONS
Early transthoracic echocardiographic assessment and the acute response to inotropic therapy may provide rapid and highly valuable information in the diagnostic workup and risk evaluation of patients with suspected LCOS after cardiac surgery.
['Zarragoikoetxea|Iratxe|I|', 'Vicente|Rosario|R|', 'Pajares|Azucena|A|', 'Carmona|Paula|P|', 'Lopez|Marta|M|', 'Moreno|Ignacio|I|', 'Argente|Pilar|P|', 'Hornero|Fernando|F|', 'Valera|Francisco|F|', 'Aguero|Jaume|J|']
D002302:Cardiac Output D002303:Cardiac Output, Low D006348:Cardiac Surgical Procedures D004280:Dobutamine D004452:Echocardiography D006801:Humans D011446:Prospective Studies
transthoracic echocardiography dobutamine cardiac surgery low cardiac output syndrome