Effects of dobutamine versus insulin on cardiac performance, myocardial oxygen demand, and total body metabolism after coronary artery bypass grafting

Abstract

Objective: The purpose was to study whether the hemodynamic benefit of a catabolic catecholamine (dobutamine) induces a certain oxygen cost for the myocardial energy demand and whether this effect would be less pronounced if an anabolic intervention, such as the administration of insulin, was used.

Design: A prospective and randomized study.

Setting: A university hospital.

Participants: Investigation of two comparable groups of cardiac patients.

Interventions: The interventions were postoperative infusions of dobutamine, 7 micrograms/kg/min, and of insulin, 1.5 U/kg/h, respectively, over a period of 30 minutes.

Measurements and main results: The effects of the interventions were measured using parameters relating to cardiac work and myocardial oxygen demand. Moreover, parameters relating to total body metabolism were also recorded. In the dobutamine group, cardiac index (CI) and left ventricular stroke work index (LVSWI) increased significantly (p < 0.05) during therapy by 30% and 40%, respectively. Cardiac effort index (CEI) and tension time index (TTI) also increased (p < 0.05) during therapy by 41% and 30%, respectively. However, in the insulin group, CI and LVSWI also increased (p < 0.01 and p < 0.05) during therapy, although to a lesser extent (16% and 14%), but CEI and TTI did not change at all during therapy. Total body CO2 production (VCO2) and O2 consumption (VO2) in the dobutamine group increased (p < 0.05) during therapy by 9% and 11%, respectively, whereas in the insulin group only CO2 production increased (p < 0.05) by 13%. O2 consumption remained unchanged in this group.

Conclusions: It is concluded that dobutamine as well as insulin administration increase cardiac performance. However, in contrast to dobutamine, insulin does not appear to increase myocardial oxygen demand. Therefore, the anabolic insulin administration may represent a more economic pattern of energy-consuming hemodynamic intervention than does the catabolic catecholamine administration.