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Acute effects of dibutyryl cyclic AMP on renal circulation in congestive heart failure
1First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Insights
Dibutyryl cyclic AMP (DBcAMP) improved hemodynamics in heart failure patients by increasing cardiac index and renal blood flow while reducing systemic and renal vascular resistance. This suggests DBcAMP is a potential treatment for congestive heart failure.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Congestive heart failure (CHF) is characterized by impaired cardiac function and altered hemodynamics.
- Current treatments aim to improve cardiac output and reduce circulatory congestion.
Purpose of the Study:
- To investigate the acute effects of intravenous dibutyryl cyclic AMP (DBcAMP) on hemodynamic parameters, renal circulation, and plasma catecholamine levels in patients with CHF.
- To assess the potential of DBcAMP as a therapeutic agent for CHF.
Main Methods:
- Eight patients with CHF (NYHA class II or III) received intravenous DBcAMP (0.1 mg/kg/min for 30 min).
- Hemodynamic variables (cardiac index, heart rate, mean aortic pressure, systemic vascular resistance), renal blood flow (RBF), and plasma catecholamine levels were measured before and during DBcAMP infusion.
Main Results:
- DBcAMP significantly increased cardiac index (+33.8%) and heart rate (+18.6%).
- DBcAMP reduced mean aortic pressure (-10.1%) and systemic vascular resistance (-31.6%), indicating afterload reduction.
- Renal blood flow increased significantly (+54.3%) with a concurrent decrease in renal vascular resistance (-34.5%).
- Plasma norepinephrine levels increased significantly.
Conclusions:
- DBcAMP demonstrates potent vasodilatory effects, improving cardiac hemodynamics through afterload reduction.
- The drug enhances renal circulation, suggesting a beneficial role in managing fluid balance in CHF.
- DBcAMP shows promise as a therapeutic option for congestive heart failure.
Abstract:
Acute effects of dibutyryl cyclic AMP (DBcAMP) on hemodynamics, renal circulation and plasma catecholamine levels were examined in 8 patients with congestive heart failure, NYHA functional class II or III. Before and during intravenous infusion of dibutyryl cyclic AMP at 0.1 mg/kg/min for 30 min, hemodynamic variables, renal blood flow (RBF) and plasma catecholamine levels were investigated. 1) DBcAMP increased the cardiac index from 2.69 +/- 0.65 to 3.60 +/- 0.84 liter/min/m2 (+ 33.8%, p less than 0.001) and heart rate from 70.9 +/- 14.3 to 84.1 +/- 15.7 bpm (+ 18.6%, p less than 0.001) and decreased mean aortic pressure from 91.8 +/- 11.3 to 82.5 +/- 9.8 mmHg (-10.1%, p less than 0.001), and systemic vascular resistance from 1840 +/- 570 to 1260 +/- 370 dynes-sec-cm-5 (-31.6%, p less than 0.001). 2) RBF increased from 335 +/- 81 to 517 +/- 188 ml/min (+ 54.3%, p less than 0.05) and renal vascular resistance decreased from 2.33 +/- 0.61 to 1.52 +/- 0.68 x 10(4) dynes-sec-cm-5 (-34.5%, p less than 0.001). 3) Plasma norepinephrine levels increased significantly. The results indicate that DBcAMP is useful for the treatment of congestive heart failure because it improves cardiac hemodynamics by afterload reduction and has a strong vasodilating effect on renal vascular beds.