An intravenous infusion of Intralipid-10% was observed to exert a negative inotropic effect on left ventricular performance in a canine isovolumetric left heart preparation. There was no effect on diastolic compliance, however. Intravenous fat emulsion also produced significant decreases in systemic vascular resistance. The mechanism of these actions has not been elucidated, but it is postulated that free fatty acid (FFA) components or their metabolites directly affect the contractile properties of both myocardium and smooth muscle. These results suggest that until suitable clinical studies can be obtained, caution should be exercised in administering intravenous fat emulsions, particularly at maximum rates of infusion or in conjunction with sodium heparin in patients with known cardiac dysfunction.
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References
1.
1. Wilmore DW, Moylan JA, Helmkamp GM, et al: Clinical evaluation of a 10% intravenous fat emulsion for parenteral nutrition in thermally injured patients. Ann Surg178:503–513, 1973.
2.
2. Jeejeebhoy KN, Zohrab WJ, Langer B, et al: Total parenteral nutrition at home for 23 months, without complication, and with good rehabilitation. A study of technical and metabolic features. Gastroenterology65:811–820, 1973.
3.
3. Zohrab WJ, McHattie JD, Jeejeebhoy KN: Total parenteral alimentation, with lipid. Gastroenterology64:583–592, 1973.
4.
4. Coran AG: Total intravenous feeding of infants and children without the use of a central venous catheter. Ann Surg179:445, 1974.
5.
5. Deitel M, Kaminsky V: Total nutrition by peripheral vein–the lipid system. Can Med Assoc J111:152–154, 1974.
7. Abel RM, Reis RL: Effects of coronary blood flow and perfusion pressure on left ventricular contractility in dogs. Circ Res27:961–971, 1970.
8.
8. Covell JW, Fuhrer JS, Boerth RC, Ross J Jr: Production of isotonic contraction in the intact canine left ventricle. J Appl Physiol27:577–581, 1969.
9.
9. Enright LP, Hannah H III, Reis RL: Effects of acute regional myocardial ischemia on left ventricular function in dogs. Circ Res26:307–3151970.
10.
10. Levine HJ, Britman NA: Force-velocity relations in the intact dog heart. J Clin Invest43:1383, 1964.
11.
11. Hefner LL, Sheffield LT, Cabbs GC et al: Relation between mural force and pressure in the left ventricle of the dog. Circ Res11:654, 1962.
12.
12. Sonnenblick EH, Strobeck JE: Derived indexes of ventricular and myocardial function. N Engl J Med296:978–982, 1977.
13.
13. Ko, K-C, Paradise RR: The effects of substrates on contractility of rat atria depressed with halothane. Anesth31:532–539, 1969.
14.
14. Weissler AM, Kruger FA, Baba N, et al: Role of anaerobic metabolism in the preservation of functional capacity and structure of anoxic myocardium. J Clin Invest47:403–416, 1968.
15.
15. Abel RM, Subramanian VA, Gay WA Jr: Effects of an intravenous amino acid nutrient solution on left ventricular contractility in dogs. J Surg Res23:201–206, 1977.
16.
16. Henderson AH, Craig RJ, Gorlin R et al: Free fatty acids and myocardial function in perfused rat hearts. Cardiovasc Res4:466–472, 1970.
17.
17. Apstein CS, Gmeiner R, Brachfeld N: Effect of palmitate on hypoxic myocardial metabolism and contractility. In Myocardiology: Recent Advances in Studies on Cardiac Structure and Metabolism. Rona G, Bajusz E (eds) Vol 1. Baltimore, University Park Press, 1972. pp 136–146.
18.
18. Henderson AG, Most AS, Parmley WW, et al: Depression of myocardial contractility in rats by free fatty acids during hypoxia. Circ Res26:439–449, 1970.
19.
19. Opie LH: Effect of fatty acids on contractility and rhythm of the heart. Nature227:1055–1056, 1970.
20.
20. Willebrands AF, Ter Welle HF, Tasseron SJA: The effect of a high molar FFA/albumin ratio in the perfusion medium on rhythm and contractility of the isolated rat heart. J Mol Cell Cardiol5:259–273, 1973.
21.
21. Hoak JC, Connor WE, Eckstein JW, Warner ED: Fatty acid-induced thrombosis and death: Mechanisms and prevention. J Lab Clin Med63:791–800, 1964.
22.
22. Jones JW, Tibbs D, McDonald LK, et al: Soybean oil emulsion as a myocardial substrate after ischemic arrest. Surg Forum28:284, 1977.
23.
23. Hillis LD, Braunwald E: Myocardial ischemia (Second of Three Parts). N Engl J Med296:1034, 1977.
24.
24. Henderson AH, Sonnenblick EH: Influence of free fatty acids on myocardial mechanics and oxygen consumption in rat papillary muscles and perfused hearts, under oxygenated and hypoxic conditions. In Myocardiology: Recent Advances in Studies on Cardiac Structure and Metabolism, Vol 1. Rona G, Bajusz E (eds) Baltimore, University Park Press, 1972. pp 147–162.
25.
25. Munk I: Ueber die Wirkungen der Fettsäuren and Seifen im Tier-körper. Zentralbl f d Med Wissensch (Berlin)27:514–516, 1889.
26.
26. Geyer RP, Watkin DM, Matthews LW et al: The vasodepressor activity of soybean phosphatide preparations. J Lab Clin Med34: 688, 1949.
27.
27. Challoner DR, Steinberg D: Effect of free fatty acid on the oxygen consumption of perfused rat heart. Am J Physiol210:280–286, 1966.
28.
28. Chaptal J, Jean R, Crastes de Paulet A, Guillaumot R, et al: Etude sur l'alimentation parenterale, lipidique et azotee chez l'enfant et chez le nourrisson deshydraté. Ann Pediat (Paris)11:441–447, 1964.
29.
29. Hallberg D, Schuberth O, Wretlind A: Experimental and clinical studies with fat emulsion for intravenous nutrition. Nutr Dieta8:245–249, 1966.
30.
30. Freuchen I, Ostergaard J: Parenteral nutrition in surgical patients. Acta Chir Scand Suppl325:55, 1964.
31.
31. Boberg J, Hallberg D: Studies on the elimination of exogenous lipids from the blood stream. Effect of heparin on the elimination. Acta Chir Scand137:749–755, 1971.
32.
32. Coran AG, Cryer PE, Horwitz DL: Effect of intravenously administered fat on serum insulin levels. Am J Clin Nutr25:131–134, 1972.
33.
33. Hahn PF: Abolishment of alimentary lipemia following injection of heparin. Science98:19–20, 1943.
34.
34. Anderson NG, Fawcett B: An antichylomicroenemic substrate produced by heparin injection. Proc Soc Exp Biol Med74:768–771, 1950.
