Dobutamine and hydralazine: Comparative influences of positive inotropy and vasodilation on coronary blood flow and myocardial energetics in nonischemic congestive heart failure

Abstract

Coronary blood flow and myocardial energetics were assessed after the administration of a parenteral inotrope (dobutamine hydrochloride) and an oral vasodilator agent (hydralazine) in 10 patients with nonischemic congestive heart failure. Dobutamine (5 micrograms/kg per min) and hydralazine (1 mg/kg) when group-matched elicited an identical increase in cardiac index and stroke volume index. Both agents augmented coronary blood flow while reducing coronary vascular resistance. Both forms of therapy elicited a significant increase in myocardial oxygen consumption. Dobutamine, demonstrating a balanced effect on the coronary circulation, induced a proportional increase in coronary blood flow and myocardial oxygen consumption, with the arterial-venous oxygen difference across the coronary vascular bed remaining unchanged. Hydralazine enhanced the myocardial oxygen supply versus demand ratio; despite a significant increase in myocardial oxygen consumption, the arterial-venous oxygen difference and the myocardial extraction ratio diminished. Both forms of therapy enhanced cardiac performance without inducing any electrocardiographic or clinical evidence of ischemia. Dobutamine, a positive inotropic agent, elicited a balanced effect on the coronary circulation while hydralazine, a vasodilator agent, induced a greater increase in coronary flow than in myocardial oxygen demand.