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To quantify the acute effects of dobutamine in postoperative low cardiac output syndrome (LCOS) using transthoracic echocardiographic, hemodynamic, and blood biomarker monitoring and to assess its association with clinical outcomes.Observational prospective study.Single university hospital.Patients undergoing elective cardiac surgery.None.Echocardiographic parameters, hemodynamic data, and plasma biomarkers were obtained before and early after inotrope initiation. The diagnostic value of transthoracic echocardiographic parameters and their association with clinical outcome were evaluated. Thirty-eight LCOS patients and 12 control patients were included. The left ventricular outflow tract velocity time integral was significantly lower in LCOS patients (11.75 v 19.08 cm; p0.001) and showed a marked improvement after dobutamine administration (∼37% increase). Dobutamine improved left and right ventricular function, increased mean arterial pressure and urine output, and lowered lactate levels. The duration of dobutamine support, but not in-hospital mortality, was associated with echocardiographic estimates of cardiac performance early after dobutamine initiation.Early transthoracic echocardiographic assessment and the acute response to inotropic therapy may provide rapid and highly valuable information in the diagnostic workup and risk evaluation of patients with suspected LCOS after cardiac surgery.

Method. All patients affected by chronic heart failure and evaluated for heart transplantation, with elevated PVR 3.0 Wood units, PAPm 25 mmHg or PCWP 15 mmHg, were included. The haemodynamic parameters measured by right heart catheterization were: pulmonary systolic, diastolic and mean pressures (PAPs, PAPd, PAPm), wedge pressure (PCWP), cardiac output (CO) and stroke volume (SV). The following variables were derived: transpulmonary pressure gradient (TPG), pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). All patients were tested by both iNO 20 ppm and 40 ppm and intravenous NaNTP, with increasing dosage, titrated on systemic pressure. The order of administration of iNO and NaNTP was randomly assigned.