Determinants of Systolic and Diastolic Flow in Coronary Bypass Grafts with Inotropic Stimulation

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Abstract
Using implanted pulsed Doppler microprobes sutured on saphenous bypass grafts in ten patients we studied, 6 h after cardiac surgery, the effects of 5 and 10 .mu.g .cntdot. kg-1 .cntdot. min-1 of dobutamine on mean (.ovrhdot.Qm), systolic (.ovrhdot.Qs), a diastolic (.ovrhdot.Qd) coronary bypass graft flows, as well as on coronary systolic (.intg. .ovrhdot.Qs) and diastolic (.intg. .ovrhdot.Qd) blood volumes entering the myocardium per cardiac beat. .ovrhdot.Qm increased during the inotropic stimulation from 61.8 .+-. 19.2 to 81.1 .+-. 21.8 ml .cntdot. min-1 (P < 0.001) and resulted from an unchanged .ovrhdot.Qs and from a large increase in .ovrhdot.Qd (P < 0.01). .ovrhdot.Qd increased more than did diastolic arterial pressured and was related to rate pressure product taken as an index of myocardial oxygen consumption (r = 0.76, P < 0.001). Despite the dobutamine-induced increase in heart rate (P < 0.01), .intg. .ovrhdot.Qs, and .intg. .ovrhdot.Qd, the systolic and diastolic inflow volumes per cardiac beat were unchanged. We conclude that increased myocardial blood supply through the saphenous vein bypass graft during inotropic stimulation by dobutamine resulted from different systolic and diastolic events. The oxygenated blood volume entering the coronary vascular bed per beat was unchanged despite tachycardia.