Hemodynamic effects of dibutyryl cyclic AMP in congestive heart failure

Abstract

To evaluate the hemodynamic effects of dibutyryl cyclic AMP (DBcAMP) in congestive heart failure (CHF), right-sided cardiac catheterization was performed in 11 patients with CHF, and hemodynamic variables were investigated before and after infusion of various doses of DBcAMP at a rate of 0.025 to 0.2 mg/kg/min (mean 0.14 ± 0.077 [standard deviation]). DBcAMP reduced total systemic vascular resistance index from 3, 171 ± 1, 158 to 1,880 ± 554 dynes s cm−5 · m2 (mean ± standard deviation) and pulmonary arterial end-diastolic pressure from 23 ± 13 to 20 ± 11 mm Hg, and increased cardiac index from 2.24 ± 0.60 to 3.41 ± 1.02 liters/min/m2. Mean arterial blood pressure decreased from 91 ± 14 to 84 ± 13 mm Hg, and heart rate increased from 91 ± 16 to 99 ± 13 beats/min. The increase in cardiac index was accompanied by a proportional decrease in total systemic vascular resistance index in all patients except 1. In 8 patients the decrease in pulmonary arterial end-diastolic pressure was accompanied by an increase or no change in the left ventricular stroke work index. In 6 patients, DBcAMP was given in incremental doses of 0.05, 0.1, and 0.2 mg/kg/min every 20 minutes, and 5 of 6 patients tolerated the full dose and showed dose-related hemodynamic changes for the incremental doses of DBcAMP. These data suggest that DBcAMP has powerful vasodilating effects on resistance vessels in patients with CHF; hence, it can be a useful vasodilating agent for treatment of CHF.