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Titolo:
Chronic infusion of dobutamine and nitroprusside in patients with end-stage heart failure awaiting heart transplantation: safety and clinical outcome
Autore:
Capomolla, S; Febo, O; Opasich, C; Guazzottia, G; Caporotondi, A; La Rovere, MT; Gnemmi, M; Mortara, A; Vona, M; Pinna, GD; Maestri, R; Cobelli, F;
Indirizzi:
IRCCS, Ist Sci Montescano, Clin Lavoro & Riabilitaz, Fdn S Maugeri, Pavia,Italy IRCCS Pavia Italy Clin Lavoro & Riabilitaz, Fdn S Maugeri, Pavia,Italy Ist Sci Pavia, Pavia, Italy Ist Sci Pavia Pavia ItalyIst Sci Pavia, Pavia, Italy Policlin Monza, Milan, Italy Policlin Monza Milan ItalyPoliclin Monza, Milan, Italy
Titolo Testata:
EUROPEAN JOURNAL OF HEART FAILURE
fascicolo: 5, volume: 3, anno: 2001,
pagine: 601 - 610
SICI:
1388-9842(200110)3:5<601:CIODAN>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
SURVIVAL TRIAL FIRST; MANAGEMENT; THERAPY; CARDIOMYOPATHY; EPOPROSTENOL; PROSTACYCLIN; IMPROVEMENT; MECHANISMS; MORTALITY; DEATH;
Keywords:
severe heart failure; chronic infusion; nitroprusside; dobutamine;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
40
Recensione:
Indirizzi per estratti:
Indirizzo: Capomolla, S IRCCS, Ist Sci Montescano, Clin Lavoro & Riabilitaz, Fdn S Maugeri, Pavia,Italy IRCCS Pavia Italy & Riabilitaz, Fdn S Maugeri, Pavia,Italy
Citazione:
S. Capomolla et al., "Chronic infusion of dobutamine and nitroprusside in patients with end-stage heart failure awaiting heart transplantation: safety and clinical outcome", EUR J HE FA, 3(5), 2001, pp. 601-610

Abstract

Background: in patients with severe heart failure additional therapeutic support with intravenous inotropic or vasodilator drugs is frequently employed in an attempt to obtain hemodynamic and clinical control. No data comparing the use and efficacy of chronic intravenous inotropic and vasodilator therapy in patients with advanced heart failure are available. Aims: we evaluated, in a group of patients with advanced heart failure undergoing chronic infusion with dobutamine or nitroprusside, in addition to optimized oral therapy, (1) the safety of chronic infusion, (2) the efficacy of both drugsin managing unloading therapy and (3) clinical outcome of the two therapeutic strategies. Methods: one hundred and thirteen patients receiving optimized oral therapy, in functional class III/IV with symptoms and signs of refractory heart failure and requiring additional pharmacological support witheither intravenous dobutamine or nitroprusside were evaluated. Clinical and therapeutic management and clinical outcome of the two groups were considered. Results: dobutamine was administered for 12 h/day for 20 +/- 23 days at a dosage of 7 +/- 3 mug/kg/min to 43 patients. The mean dose of nitroprusside was 0.76 +/- 0.99 mug/kg/min. The mean duration of use of this drug, administered as a 12-h/day infusion was 22 +/- 38 days. Nitroprusside infusion allowed greater doses of short-term ACE-inhibitors to be used compared to pre-infusion (ACE-inhibitor dose: 55 +/- 30 mg/day vs. 127 +/- 30 mg/dayP < 0.0001) and during dobutamine infusion (ACE-inhibitor dose: 85 +/- 47 mg/day vs. 127 +/- 30 mg/day P < 0.002). Nitroprusside unlike dobutamine significantly improved the NYHA functional class. Of the 113 patients, 109 (97%) had a cardiac event during a mean follow-up of 337 +/- 264 days. Forty-four patients required hospitalization for worsening congestive heart failure, 45/113 (39%) patients died during the follow-up and 27/113 (24%) patients had a heart transplant in status one. Hospitalization, because of worsening heart failure was less frequent in the nitroprusside than in the dobutamine subgroup [29/51 (57%) vs. 19/22 (86%) P < 0.02]. The overall mortalitywas 28% (20/70) in the nitroprusside group and 58% (25/43) in the dobutamine group (odds ratio 0.33 CI 0.16 to 0.73 P < 0.006). In the group treated with nitroprusside, heart transplantation in status one was performed in 16/33 patients (48%), while in the dobutamine group this was done in 11/14 patients (78%) (odds ratio 0.25 CI 0.06-1.02 P < 0.06). There was a significant reduction in the combined end-point of mortality/heart transplantation in status one in patients treated with nitroprusside compared to those treated with dobutamine (36/70 (51%) vs. 36/43 (84%) - (odds ratio 0.34 CI 0.14-0.80 P < 0.01). The incidence of adverse events in the patients treated with nitroprusside was similar to that in those treated with dobutamine (20% vs. 17% P = ns). Conclusions: for patients awaiting heart transplantation chronic intermittent nitroprusside infusions are more effective and safer than dobutamine in relieving symptoms, facilitating unloading therapy management and improving survival. Whether chronic intermittent infusion of nitroprusside could represent a feasible medical strategy in out-patients with severe heart failure remains to be investigated. (C) 2001 European Society of Cardiology. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/06/20 alle ore 23:55:22