Circulation, Vol 84, 168-176, Copyright © 1991 by American Heart Association
RD Hoeldtke, KM Davis, J Joseph, R Gonzales, IP Panidis and AC Friedman
BACKGROUND. The somatostatin analogue, ectrootide, is being used to treat
postprandial hypotension in patients with autonomic neuropathy. Although
the therapeutic effect of the drug is presumably secondary to a splanchnic
vasoconstrictor action, its effect on splanchnic hemodynamics has never
been characterized in patients with autonomic neuropathy. Moreover, it is
unknown whether octreotide acts on other vascular beds in this group of
patients or whether it affects cardiac output. We, therefore, measured
splanchnic, forearm, and systemic vascular resistance and cardiac output
before and after administering octreotide (0.4 microgram/kg s.c.) to
patients with idiopathic autonomic neuropathy and diabetic autonomic
neuropathy. METHODS AND RESULTS. Splanchnic blood flow was determined from
the clearance of indocyanine green in seven patients. We observed that
octreotide decreased splanchnic blood flow (from 850 +/- 77 to 664 +/- 48
ml/min, p less than 0.005), increased mean blood pressure (from 97 +/- 6 to
115 +/- 3 mm Hg, p less than 0.005), and increased splanchnic vascular
resistance (from 0.118 +/- 0.012 to 0.18 +/- 0.018 mm Hg/ml/min, p less
than 0.005). Forearm blood flow was measured by plethysmography in 13
patients. Octreotide increased forearm vascular resistance in patients with
idiopathic autonomic neuropathy (n = 8) from 19.1 +/- 1.0 to 27.2 +/- 3.8
mm Hg/ml/min/100 ml forearm volume (p less than 0.01) and from 25.2 +/- 3.9
to 41.0 +/- 6.8 mm Hg/ml/min/100 ml (p less than 0.01) in patients with
diabetic autonomic neuropathy (n = 5). Cardiac output was measured by
two-dimensional echocardiography. Octreotide administration increased
cardiac output in five of six patients with idiopathic autonomic neuropathy
(from 4.4 +/- 0.4 to 5.0 +/- 0.5 l/min, p less than 0.02) and five of five
patients with diabetic autonomic neuropathy (from 3.8 +/- 0.4 to 5.1 +/-
0.4 l/min, p less than 0.02). Systemic vascular resistance increased in
patients with idiopathic autonomic neuropathy from 21.2 +/- 2 to 24.9 +/-
2.6 (p less than 0.05) but did not change in patients with diabetic
autonomic neuropathy. CONCLUSION. The pressor effect of octreotide in
patients with autonomic neuropathy is associated with increased splanchnic
and forearm vascular resistance and with increased cardiac output.
ARTICLES
Hemodynamic effects of octreotide in patients with autonomic neuropathy
General Clinical Research Center, Temple University Hospital, Philadelphia.
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