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Published on: April 8, 2013
The effect of landiolol on hemodynamics and left ventricular function in patients with coronary artery disease
Koji Goto1, Chihiro Shingu, Shinji Miyamoto
1Department of Anesthesiology, Faculty of Medicine, Oita University, Oita, Japan. ko.goto@med.oita-u.ac.jp
Insights
Landiolol effectively lowers heart rate in patients undergoing coronary artery bypass surgery. However, it may worsen cardiac function in those with reduced left ventricular ejection fraction (EF).
Area of Science:
- Cardiology
- Pharmacology
- Cardiovascular Surgery
Background:
- Landiolol is an ultra-short-acting beta-blocker used for rate control.
- Its effects on hemodynamics and left ventricular (LV) function in patients undergoing coronary artery bypass surgery require further investigation.
Purpose of the Study:
- To evaluate the impact of landiolol on hemodynamic parameters and LV function in patients undergoing elective off-pump coronary artery bypass surgery.
- To compare these effects between patients with normal and reduced preoperative LV ejection fraction (EF).
Main Methods:
- A prospective, observational study involving 56 adult patients with angina pectoris undergoing elective off-pump coronary artery bypass surgery.
- Patients were divided into normal EF (≥50%) and low EF (<50%) groups.
- Hemodynamics and LV function were assessed using pulmonary artery catheter and transesophageal echocardiography before, during, and after landiolol administration.
Main Results:
- Landiolol significantly decreased heart rate (HR) in both groups, with values returning to baseline post-administration.
- In the normal EF group, cardiac index remained stable, with increases in stroke index and stroke volume.
- In the low EF group, cardiac index decreased alongside HR, without compensatory increases in end-diastolic volume or stroke volume; mean arterial pressure decreased slightly.
Conclusions:
- Landiolol administration at the recommended dose decreases HR without negatively impacting hemodynamics in patients with normal cardiac function.
- In patients with preoperative EF <50%, landiolol may lead to further cardiac function deterioration due to HR reduction.
Study Objective:
To examine the effect of landiolol (normal dose) on hemodynamics and left ventricular (LV) function.
Design:
Prospective, observational, repeated-measures study.
Setting:
University hospital.
Patients:
56 adult patients who were diagnosed with angina pectoris and who underwent elective off-pump coronary artery bypass surgery.
Interventions:
Patients were divided into two groups based on a preoperative LV ejection fraction (EF) 50% or higher (normal EF group, n = 28) and lower than 50% (low EF group, n = 28). Hemodynamics and LV function were recorded using a pulmonary artery catheter and transesophageal echocardiography at three time points (before administration of landiolol, immediately before completion of administration, and 15 minutes after completion of administration).
Measurements:
Individual hemodynamic data were obtained using a pulmonary artery catheter, and individual parameters were determined from LV short-axis views in transesophageal echocardiography.
Main Results:
Mean preoperative EFs were 57% +/- 5% and 47% +/- 3% in the normal and low EF groups, respectively. In both groups, landiolol produced a significant decrease in heart rate (HR), which then returned to baseline 15 minutes after completion of administration. A significant decrease in mean arterial pressure occurred in the low EF group, but the decrease was within 30% of baseline. In the normal EF group, there was no decrease in cardiac index, but a significant increase in stroke index, in addition to an increase in stroke volume. In the low EF group, cardiac index significantly decreased along with the decrease in HR, but there was no increase in end-diastolic volume or stroke volume.
Conclusions:
Administration of landiolol using the presently recommended dosage and administration route causes a decrease in HR without aggravation of hemodynamics in patients with normal cardiac function, but in patients with preoperative EF lower than 50%, it may lead to further deterioration of cardiac function due to a decrease in HR.
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