Jn. Nanas et al., Long-term intermittent dobutamine infusion combined with oral amiodarone improves the survival of patients with severe congestive heart failure, CHEST, 119(4), 2001, pp. 1173-1178
Citations number
42
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Study objective: To evaluate the effects of long-term intermittent dobutami
ne infusion (IDI) with concomitant administration of low-dose amiodarone in
patients with congestive heart failure (CHF) refractory to standard medica
l treatment.
Design: Prospective, interventional clinical trial.
Setting: Inpatient and outpatient heart failure clinic in a university teac
hing hospital.
Patients and interventions: Twenty-two patients with CHF refractory to stan
dard treatment who could be weaned from dobutamine therapy after an initial
72-h infusion were included in this study. The first 11 patients (group 1)
were treated with IDI, 10 mug/kg/min, as needed (mean, once every 16 days,
lasting for 12 to 48 h); the next 11 patients (group 2) received oral amio
darone, 480 mg/d, and IDI, 10 mug/kg/min, for 8 h every 7 days.
Measurement and results: There were no differences in baseline clinical, he
modynamic, and five biochemical characteristics between the two groups. The
left ventricular ejection fraction was 13.5 +/- 4.5% in group 1 vs 15.5 +/
- 4.9% in group 2 (mean +/- SD; p = 0.451); mean pulmonary capillary wedge
pressure was 31.3 +/- 4.4 mm Hg vs 29.4 +/- 3.3 mm Hg (p = 0.316); serum cr
eatinine was 1.9 +/- 0.4 mg/dL vs 1.6 +/- 0.5 mg/dL (p = 0.19); and serum N
a was 139.6 +/- 6.2 mEq/L vs 138.4 +/- 3.1 mEq/L (p = 0.569). At 12 months
of follow-up, 1 of 11 patients (9%) was alive in group 1 vs 6 of 11 patient
s (55%) in group 2 (p = 0.011). Furthermore, in group 2, the functional sta
tus improved significantly within the first 3 months of treatment, from New
York Heart Association functional class IV to 2.63 +/- 0.5 (p = 0.0001).
Conclusion: Long-term IDI in conjunction,vith amiodarone, added to conventi
onal drugs, improved clinical status and survival of patients with severe C
HF.