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Titolo:
Dobutamine as bridge to angiotensin-converting enzyme inhibitor-nitrate therapy in endstage heart failure
Autore:
Levine, TB; Levine, AB; Elliott, WG; Narins, B; Stomel, RJ;
Indirizzi:
Botsford Gen Hosp, Michigan Inst Heart Failure & Transplant Care, Farmington Hills, MI 48336 USA Botsford Gen Hosp Farmington Hills MI USA 48336 ngton Hills, MI 48336 USA
Titolo Testata:
CLINICAL CARDIOLOGY
fascicolo: 3, volume: 24, anno: 2001,
pagine: 231 - 236
SICI:
0160-9289(200103)24:3<231:DABTAE>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEFT-VENTRICULAR DYSFUNCTION; INTRAVENOUS MILRINONE; VASODILATOR THERAPY; DILATED CARDIOMYOPATHY; PROGRESSION; ENALAPRIL; RESPONSES;
Keywords:
parenteral inotropic therapy; dobutamine; angiotensin-converting enzyme inhibitor; vasodilators; decompensated heart failure; prognosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Levine, TB Botsford Gen Hosp, Michigan Inst Heart Failure & Transplant Care, 28050 Grand River Ave, Farmington Hills, MI 48336 USA Botsford Gen Hosp 28050 Grand River Ave Farmington Hills MI USA 48336
Citazione:
T.B. Levine et al., "Dobutamine as bridge to angiotensin-converting enzyme inhibitor-nitrate therapy in endstage heart failure", CLIN CARD, 24(3), 2001, pp. 231-236

Abstract

Background: Intravenous inotropic intervention in congestive heart failureis generally associated with a poor prognosis and is largely used as a "bridge" to mechanical support or heart transplantation. Hypothesis: We hypothesized that the inotropic support afforded by dobutamine may serve as a bridge to the introduction and intensification of angiotensin-converting enzyme (ACE) inhibitor-nitrate therapy. Methods: We studied the efficacy of transitioning inotrope-dependent patients in endstage heart failure from intravenous dobutamine to high-dose ACE inhibitor-nitrates, with 1-year follow-up. Forty-nine sequential dobutamine-dependent patients with left ventricular ejection fraction (LVEF) 17 +/- 17% were treated with increasing lisinopril (1.9 +/- 1.5 to 46 +/- 28 mg/day) and isosorbide dinitrate (7 +/- 6 to 229 +/- 161 mg/day). Outpatient dobutamine was continued or repeat infusions pursued, as indicated, and dobutamine was tapered when feasible. Results: During the following year, 14 of 49 patients required repeat dobutamine, with home treatment with dobutamine for 6.3 +/- 3.7 months (n = 5). At 1 year, New York Heart Association (NYHA) classification improved from 3.6 +/- 0.5 to 1.9 +/- 1.0, p < 0.0001; yearly hospitalizations fell from 2.7 +/- 2.3 to 1.2 +/- 3.0, p = 0.02; and LVEF rose from 17 +/- 7% to 24 +/-11%, p < 0.0001. At 1 year, 14 patients who remained dobutamine dependent had significantly more severe symptoms than dobutamine-independent patients(n = 35). Transplant or death occurred in 7 of 14 patients with follow-up dobutamine, and in 5 of 35 patients free of subsequent dobutamine, p = 0.03. Patients with poor outcome (transplant n = 10, death n = 12) continued tobe more limited (NYHA 2.7 +/- 0.9 vs. 1.7 +/- 0.9, p = 0.0002), with more follow-up hospitalizations (3.6 +/- 5.3 vs. 0.6 +/- 0.8, p = 0.0004), and no improvement in LVEF (17 +/- 8 vs. 28 +/- 11%, p = 0.003). Conclusions: Of the patients on dobutamine inotropic support, 70% were successfully transitioned to ACE inhibitor-nitrate therapy, with improved symptoms and LVEF and with reduced hospitalizations and follow-up dobutamine ortransplant. Thirty percent of patients with continued need for dobutamine had a significantly poorer 1-year clinical outcome.

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Documento generato il 07/07/20 alle ore 12:27:30