Abstract： Objective To use tissue Doppler strain rate imaging to evaluate the impact of low dose dopamine and milrinone on systolic and diastolic function of the left ventricle of patients undergoing heart valve replacement. Methods Forty patients undergoing selective heart valve replacement in West China Hospital of Sichuan University between March and May 2011 were included in this study. All the patients were randomized into 2 groups with 20 patients in each group： milrione group and dopamine group. After anesthesia induction and before cardiopulmonary bypass setup， left ventricular ejection fraction （LVEF） was measured by echocardiography. Tissue Doppler strain rate imaging was used to measure the left ventricular lateral wall and midventricular segment from the four-chamber view， which was compared with Doppler parameters. Results LVEF， ratio of early-diastolic to end-diastolic velocity （E/A） of transmitral flow， ratio of mitral inflow velocity to early diastolic velocity in the annulus （E/Et） of both 2 groups were significantly different between before and after dopamine and milrinone administration （P＜0. 05）. In the milrinone group， 4 segments systolic peak velocity （Vs）， 1 segment early diastolic peak velocity （Ve）， 4 segments late diastolic peak velocity （Va）， 3 segments Ve/Va ratio， 2 segments systolic peak strain rate （SRs）， 2 segments late diastolic peak strain rate （SRa）， and 3 segments early diastolic peak strain rate SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0. 05）. In the dopamine group， 4 segments systolic peak velocity （Vs）， 1 segment Ve， 4 segments Va， 1 segment Ve/Va ratio， 2 segments SRs， 1 segment SRe， 1 segment SRa， and 1 segment SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0.05）. To compare the milrione group and dopamine group after medication administration， 2 segments Vs， 4 segments Va， 1 segment SRe， 1 segment SRa， 2 segments Ve/Va ratio， and 2 segments SRe/SRa ratio of the milrione group were significantly higher than those of the dopamine group （P＜0.05）， and 1 segment Vs， two segments SRs of the milrione group were significantly lower than those of the dopamine group （P＜0.05）. Conclusion Both milrinone and dopamine can improve left ventricular systolic function of perioperative patients undergoing heart valve replacement assessed by tissue Doppler strain rate imaging， while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.
Citation：
LI Xia,PENG Ling,WEI Wei.. Tissue Doppler Strain Rate Imaging to Evaluate the Impact of Dopamine and Milrinone on Left Ventricular Function of Patients Undergoing Heart Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 43-48. doi:
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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Weidemann F， Jamal F， Sutherland GR， et al. Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol， 2002， 283 （2）： H792-H799.
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Bayram M， De Luca L， Massie MB， et al. Reassessment of dobutamine， dopamine， and milrinone in the management of acute heart failure syndromes. Am J Cardiol， 2005， 96 （6A）： 47G-58G.
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Yamada T， Takeda J， Katori N， et al. Hemodynamic effects of milrinone during weaning from cardiopulmonary bypass： comparison of patients with a low and high prebypass cardiac index. J Cardiothorac Vasc Anesth， 2000， 14 （4）： 367-373.
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张晓庆， 杭燕南， 孙大金. 米力农联合多巴胺用于重症心内直视术停机过程. 临床麻醉学杂志， 2000， 7 （7）：328-331．.
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Barraud D， Faivre V， Damy T， et al. Levosimendan restores both systolic and diastolic cardiac performance in lipopolysaccharide-treated rabbits： comparison with dobutamine and milrinone. Crit Care Med， 2007， 35 （5）： 1376-1382.
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Y?lmaz O， Ceylan O， Orün UA， et al. Assessment of left ventricular functions with tissue Doppler， strain and strain rate echocardiography in children with juvenile idiopathic arthritis： An observational study. Anadolu Kardiyol Derg， 2012， 12 （4）： 339-346.
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Sim?ek Z， Karakelleo?lu S， Gündo?du F， et al. Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis. Anadolu Kardiyol Derg， 2010， 10 （4）：328-333.
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Simsek Z， Gundogdu F， Alpaydin S， et al. Analysis of athletes' heart by tissue Doppler and strain/strain rate imaging. Int J Cardiovasc Imaging， 2011， 27 （1）： 105-111.
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Tümüklü MM， Etikan I， Cinar CS. Left ventricular function in professional football players evaluated by tissue Doppler imaging and strain imaging. Int J Cardiovasc Imaging， 2008， 24 （1）： 25-35.
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梁晓霞， 芦芳， 赵敏. 斑点追踪成像技术评价心力衰竭左室心肌应变的价值. 中西医结合心脑血管病杂志，2009，7 （5）：517-518.
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Koyama J， Ray-Sequin PA， Falk RH. Longitudinal myocardial function assessed by tissue velocity， strain， and strain rate tissue Doppler echocardiography in patients with AL （primary） cardiac amyloidosis. Circulation， 2003， 107 （19）： 2446-2452.
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- 1. Weidemann F， Jamal F， Sutherland GR， et al. Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol， 2002， 283 （2）： H792-H799.
- 2. Bayram M， De Luca L， Massie MB， et al. Reassessment of dobutamine， dopamine， and milrinone in the management of acute heart failure syndromes. Am J Cardiol， 2005， 96 （6A）： 47G-58G.
- 3. Kikura M， Levy JH， Michelsen LG， et al. The effect of milrinone on hemodynamics and left ventricular function after emergence from cardiopulmonary bypass. Anesth Analg， 1997， 85 （1）： 16-22.
- 4. Yamada T， Takeda J， Katori N， et al. Hemodynamic effects of milrinone during weaning from cardiopulmonary bypass： comparison of patients with a low and high prebypass cardiac index. J Cardiothorac Vasc Anesth， 2000， 14 （4）： 367-373.
- 5. 张晓庆， 杭燕南， 孙大金. 米力农联合多巴胺用于重症心内直视术停机过程. 临床麻醉学杂志， 2000， 7 （7）：328-331．.
- 6. Barraud D， Faivre V， Damy T， et al. Levosimendan restores both systolic and diastolic cardiac performance in lipopolysaccharide-treated rabbits： comparison with dobutamine and milrinone. Crit Care Med， 2007， 35 （5）： 1376-1382.
- 7. Couture P， Denault AY， Pellerin M， et al. Milrinone enhances systolic， but not diastolic function during coronary artery bypass grafting surgery. Can J Anaesth， 2007， 54 （7）：509-522.
- 8. Axelsson B， Arbeus M， Magnuson A， et al. Milrinone improves diastolic function in coronary artery bypass surgery as assessed by acoustic quantification and peak filling rate： a prospective randomized study. J Cardiothorac Vasc Anesth， 2010， 24 （2）： 244-249.
- 9. Price DJ， Wallbridge DR， Stewart MJ. Tissue doppler imaging： current and potential clinical applications. Heart， 2000， 84 （Suppl Ⅱ）： Ⅱ11-Ⅱ18.
- 10. Meluzín J， Spinarová L， Bakala J， et al. Pulsed doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new， rapid， and non-invasive method of evaluating right ventricular systolic function. Eur Heart J， 2001， 22 （4）： 340-348.
- 11. Dae-Won S， In-Ho C， LEE Dong-jun， et al. Assessment of mitral annulus velocity by doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol， 1997， 30 （2）： 474-480.
- 12. Oh JK， Hatle L， Tajik AJ， et al. Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography. J Am Coll Cardiol， 2006， 47 （3）： 500-506.
- 13. Y?lmaz O， Ceylan O， Orün UA， et al. Assessment of left ventricular functions with tissue Doppler， strain and strain rate echocardiography in children with juvenile idiopathic arthritis： An observational study. Anadolu Kardiyol Derg， 2012， 12 （4）： 339-346.
- 14. Sim?ek Z， Karakelleo?lu S， Gündo?du F， et al. Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis. Anadolu Kardiyol Derg， 2010， 10 （4）：328-333.
- 15. Simsek Z， Gundogdu F， Alpaydin S， et al. Analysis of athletes' heart by tissue Doppler and strain/strain rate imaging. Int J Cardiovasc Imaging， 2011， 27 （1）： 105-111.
- 16. Tümüklü MM， Etikan I， Cinar CS. Left ventricular function in professional football players evaluated by tissue Doppler imaging and strain imaging. Int J Cardiovasc Imaging， 2008， 24 （1）： 25-35.
- 17. 梁晓霞， 芦芳， 赵敏. 斑点追踪成像技术评价心力衰竭左室心肌应变的价值. 中西医结合心脑血管病杂志，2009，7 （5）：517-518.
- 18. Koyama J， Ray-Sequin PA， Falk RH. Longitudinal myocardial function assessed by tissue velocity， strain， and strain rate tissue Doppler echocardiography in patients with AL （primary） cardiac amyloidosis. Circulation， 2003， 107 （19）： 2446-2452.
