[Enoximone, vasodilator and/or inotropic agent in congestive cardiac insufficiency? Hemodynamic and ventriculographic study of 20 cases].
The aim of this study was to document the effects of enoximone in congestive cardiac failure. The haemodynamic data (aortic pressure, pulmonary pressures, left ventricular pressure, cardiac output, isovolumic contractility index: Vmax) and left ventricular kinetics of 20 patients with dilated cardiomyopathy (11 ischemic and 9 idiopathic in Stages III or IV of the NYHA Classification before recompensation) were recorded under basal conditions, after 30 minutes infusion of dobutamine (10 micrograms/kg/mn) and after 3 hours infusion of enoximone (total dose: 3.6 mg/kg). The two drugs had an equivalent inotropic effect: ejection fraction + 4 +/- 22% with dobutamine and + 16 +/- 39% with enoximone; Vmax increased from 1.53 +/- 0.5 c/sec to 2.49 +/- 0.8 c/sec with dobutamine and to 1.82 +/- 0.5 c/sec with enoximone. Enoximone induced a greater degree of vasodilation (systemic resistances - 14 +/- 21% with dobutamine and - 21 +/- 27% with enoximone) and a more pronounced fall in ventricular filling pressures (- 35 +/- 42% with dobutamine and - 58 +/- 24% with enoximone). Enoximone was less effective than dobutamine in increasing cardiac output (+ 46 +/- 42% with dobutamine and 16 +/- 33% with enoximone) and stroke volume (+ 23 +/- 47% with dobutamine and + 2 +/- 41% with enoximone). This difference in efficacy may be explained by the major reduction in ventricular preload which enoximone induced after that observed with dobutamine. "Responders" (12 patients) had basal cardiac outputs of less than 2.3 l/mn/m2; the peripheral vasodilatation caused by enoximone was greater. Finally, the reduction in left ventricular end diastolic pressure and the increase in Vmax were significantly less in the 11 patients with ischemic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
Durrieu
C
C
Laboratoire d'hémodynamique, INSERM U 8, hôpital cardiologique, université de Bordeaux.
Rochoux
G
G
Coste
P
P
Le Goff
G
G
Besse
P
P
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002311:Cardiomyopathy, Dilated / Q000150:complications; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002932:Cineangiography; D004280:Dobutamine / Q000494:pharmacology / Q000627:therapeutic use; D017335:Enoximone; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D014664:Vasodilation / Q000187:drug effects*
D002316:Cardiotonic Agents; D007093:Imidazoles; D004280:Dobutamine; D017335:Enoximone
Enoximone, vasodilatateur et/ou inotrope dans l'insuffisance cardiaque congestive? Etude hémodynamique et ventriculographique à propos de 20 cas.