TY - JOUR
TI - Reverse left ventricular remodeling by intermittent dobutamine infusions
and amiodarone in end-stage heart failure due to idiopathic dilated
cardiomyopathy
AU - Nanas, JN
AU - Tsagalou, EP
AU - Nanas, SN
AU - Terrovitis, JV and
AU - Tsolakis, EJ
AU - Toumanidis, S
AU - Papazoglou, PD
AU - Alexopoulos, GP
AU - and Kanakakis, J
AU - Anastasiou-Nana, MI
JO - International Journal of Cardiology
PY - 2006
VL - 108
TODO - 2
SP - 237-243
PB - Elsevier Ireland Ltd
SN - 0167-5273
TODO - 10.1016/j.ijcard.2005.05.010
TODO - end-stage heart failure; reverse remodeling; inotropes; amiodarone
TODO - Background: The aim of this study was to evaluate the long-term effect
of combined intermittent dobutamine infusions (IDI) and oral amiodarone
on reverse left ventricular (LV) remodeling and hemodynamics of patients
with idiopathic dilated cardiomyopathy (IDC) and end-stage congestive
heart failure (CHF).
Methods: This non-randomized, prospective, clinical trial included
sixteen consecutive patients suffering from dyspnea for a mean of 76 43
months, who presented with acute cardiac decompensation and were weaned
from dobutamine therapy after an initial 72-h infusion. They were then
placed on a regimen of oral amiodarone, 400 mg/day and weekly IDI, 10 mu
g/kg/min, for 8 h. The long-term clinical outcomes and the effects of
treatment on reverse LV remodeling (echocardiographic parameters) and
hemodynamics were evaluated at 3, 6, and 12 months of follow up.
Results: A significant degree of reverse LV remodeling, hemodynamic
improvements, and survivals > 1.5 years were observed in 9 of the 16
patients (56%). In addition, 5 patients (31% of entire cohort) were
weaned from IDI after a mean of 61 41 weeks, and 4 remained clinically
stable for 116 66 weeks thereafter. At 12 months of follow-up, LV
end-diastolic and end-systolic volume indices had decreased from 231 +/-
91 to 206 +/- 80 ml/m(2) (P=0.002) and from 137 +/- 65 to 110 +/-
50ml/m(2) (p= 0.003), respectively, right atrial pressure from 16 +/- 6
to 5.6 +/- 4 mm Hg, (P=0.031), and pulmonary capillary wedge pressure
from 29 +/- 4 to 16 +/- 5.4 min Hg, P=0.000, while LV ejection fraction
had increased from 22 +/- 6% to 27.3 +/- 8% (P = 0.006).
Conclusions: In end-stage CHF due to IDC, long-term treatment with IDI
and oral amiodarone caused reverse LV remodeling, and allowed permanent
and successful weaning from IDI in 1/4 of patients. (c) 2005 Elsevier
Ireland Ltd. All rights reserved.
ER -