Effects of piroximone on the right ventricular function in severe heart failure patients.
OBJECTIVE
To assess the effects of piroximone, a phosphodiesterase inhibitor, on right ventricular function in patients with heart failure.


METHODS
Randomized study: patients were randomly assigned to the piroximone infusion rate of 5 or 10 micrograms/kg/min.


METHODS
Cardiologic intensive care unit.


METHODS
12 consecutive patients with severe heart failure.


METHODS
Right heart catheterization was performed using a Swan-Ganz ejection fraction thermodilution catheter.


RESULTS
Measurements of right ventricular ejection fraction (RVEF), end-diastolic and end-systolic right ventricular volumes were obtained using the thermodilution principle. To determine contractility indexes, the relationships between end-systolic pulmonary arterial pressure (ESPAP) over right ventricular end-systolic volume (RVESV) and ESPAP over RVEF were calculated during the infusion of prostacyclin at incremental infusion rates of 2, 4, 6 and 8 ng/kg/min. The slope of the relation between ESPAP over RVESV shifted during piroximone therapy from 7.635 +/- 1.632 to 1.975 +/- 0.432 (p < 0.01) and from 6.092 +/- 1.99 to 1.028 +/- 0.853 (p < 0.05) at 5 and 10 micrograms/kg/min piroximone infusion, respectively. The slope of the relation between ESPAP over RVEF decreased from -0.414 +/- 0.296 to -0.821 +/- 0.257 (p < 0.01) and from -0.127 +/- 0.048 to - 0.533 +/- 0.135 (p < 0.05) at 5 and 10 micrograms/kg/min piroximone infusion, respectively.


CONCLUSIONS
This study suggests a positive action of piroximone on right ventricular contractility at these 2 dosages. This approach using this type of catheter allowed us to determine right ventricular inotropic indexes.
Saal
J P
JP
Département de Cardiologie, INSERM U2, Hôpital Henri Mondor, Créteil, France.
Habbal
R
R
Estagnasie
P
P
Lellouche
D
D
Castaigne
A
A
Dubois-Randé
J L
JL
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D011464:Epoprostenol / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D016278:Ventricular Function, Right / Q000187:drug effects*
D002316:Cardiotonic Agents; D007093:Imidazoles; D010726:Phosphodiesterase Inhibitors; C039686:piroximone; D011464:Epoprostenol