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Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death

Publication ,  Journal Article
Meyers, CH; D'Amico, TA; Peterseim, DS; Jayawant, AM; Steenbergen, C; Sabiston, DC; Van Trigt, P; Young, J; Egan, T; McKeown, P
Published in: Journal of Heart and Lung Transplantation
January 1, 1993

Previous studies have documented decreases in serum-free triiodothyronine (T3) after brain death and improved hemodynamics with its replacement, suggesting its controversial, but promising, clinical utility for managing potential organ donors. Vasopressin is also commonly used clinically as a pressor agent after brain death. A load-independent analysis of cardiac function and an assessment of myocardial blood flow (MBF) with these agents have not been reported, however. Eighteen pigs were instrumented with left ventricular epicardial dimension transducers and a left ventricular micromanometer. MBF was assessed by standard microsphere techniques. Baseline left ventricular pressure-dimension data were collected, and brain death was induced by ligating the innominate and left subclavian arteries. Left ventricular function data were collected every 30 minutes after brain death to 6 hours or until the animal died. Microsphere injections were performed before brain death and hourly thereafter to 4 hours. At 90 minutes after brain death, animals were assigned to a vasopressin (2 units/hr, intravenously, n = 6), T3 (0.05 μg/kg/hr, intravenously, n = 6), or control (n = 6) treatment group. Preload recruitable stroke work (PRSW), a load-independent index of left ventricular function, was derived from the pressure-dimension data. MBF was calculated by conventional methods. At 4 hours after brain death, PRSW and MBF decreased significantly in the control, vasopressin, and T3 groups relative to the baseline, pre-brain dead state (PRSW: -36% ± 12%, -48% ± 7%, -52% ± 5%; MBF: -27% ± 15%, -38% ± 5%, -78% ± 2%, respectively). Neither vasopressin nor T3, however, showed any advantage over the control group in terms of preserving left ventricular function or prolonging survival. Furthermore, these data show a marked decrease in MBF in the T3 group (p < 0.01 versus control and vasopressin groups) without a significant change in cardiac function. Analysis of endocardial to epicardial flow ratios disclosed no significant differences between groups at any time. In summary, animals treated with T3 had a greater decline in MBF than the control group at 4 hours, without any benefit to cardiac function. Further studies examining the mechanism responsible for the deterioration of MBF and cardiac dysfunction will be necessary to optimally manage the brain dead patient before organ harvest, especially regarding the precise role of T3.

Duke Scholars

Published In

Journal of Heart and Lung Transplantation

ISSN

1053-2498

Publication Date

January 1, 1993

Volume

12

Issue

1 I

Start / End Page

68 / 80

Related Subject Headings

  • Surgery
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Meyers, C. H., D’Amico, T. A., Peterseim, D. S., Jayawant, A. M., Steenbergen, C., Sabiston, D. C., … McKeown, P. (1993). Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death. Journal of Heart and Lung Transplantation, 12(1 I), 68–80.
Meyers, C. H., T. A. D’Amico, D. S. Peterseim, A. M. Jayawant, C. Steenbergen, D. C. Sabiston, P. Van Trigt, J. Young, T. Egan, and P. McKeown. “Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death.” Journal of Heart and Lung Transplantation 12, no. 1 I (January 1, 1993): 68–80.
Meyers CH, D’Amico TA, Peterseim DS, Jayawant AM, Steenbergen C, Sabiston DC, et al. Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death. Journal of Heart and Lung Transplantation. 1993 Jan 1;12(1 I):68–80.
Meyers, C. H., et al. “Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death.” Journal of Heart and Lung Transplantation, vol. 12, no. 1 I, Jan. 1993, pp. 68–80.
Meyers CH, D’Amico TA, Peterseim DS, Jayawant AM, Steenbergen C, Sabiston DC, Van Trigt P, Young J, Egan T, McKeown P. Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death. Journal of Heart and Lung Transplantation. 1993 Jan 1;12(1 I):68–80.
Journal cover image

Published In

Journal of Heart and Lung Transplantation

ISSN

1053-2498

Publication Date

January 1, 1993

Volume

12

Issue

1 I

Start / End Page

68 / 80

Related Subject Headings

  • Surgery
  • 1102 Cardiorespiratory Medicine and Haematology