Low-dose enoximone therapy in pre-transplant patients: hemodynamic, echocardiographic, and neurohumoral findings.
Keeping pre-transplant patients alive while waiting for a suitable donor to be found is still a major challenge. New pharmacological agents which can provide improved hemodynamics are urgently needed in patients with severe heart failure who are on the waiting list for cardiac transplantation. Intravenous enoximone therapy (an initial 0.5 mg/kg bolus, then 1.25-5.0 mcg/kg/min infusion) was administered to 18 transplant candidates with heart failure progression despite optimal drug regimen including digoxin, diuretics, and ACE-inhibitors. Complete hemodynamic, echocardiographic, and neurohumoral studies were performed before and 24 h after intravenous enoximone infusion. Enoximone infusion increased cardiac index (1.78 +/- 0.45 l/min/qm vs. 3.04 +/- 0.83 l/min/qm; p < 0.001) and stroke volume index (22.33 +/- 9.45 ml/qm vs. 32.28 +/- 7.29 ml/qm; p < 0.05) and decreased wedge pressure (24.1 +/- 11.98 mmHg vs. 17.78 +/- 8.76 mmHg; p < 0.05) and systemic vascular resistance (1700.8 +/- 555.8 dyn x s x cm-5 vs. 952.8 +/- 384.0 dyn x s x cm-5; p < 0.001). Heart rate and mean arterial pressure were unchanged. Left ventricular ejection time (225.1 +/- 26.9 ms vs. 242.2 +/- 25.8 ms; p < 0.05) was increased, whereas other echocardiographic parameters were unchanged (left ventricular end-diastolic dimension, left ventricular end-systolic dimension, fractional shortening, early diastolic relaxation parameter Te). Plasma neurohumoral parameters did not change (aldosterone, epinephrine, renin, atrial natriuretic factor) except for a significant drop of norepinephrine (936.7 +/- 443.2 pg/ml vs. 522.4 +/- 287.6 pg/ml; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Park
J W
JW
Herzzentrum KWK Duisburg.
Heinzler
R
R
Wirtz
J H
JH
Fieten-Rumswinkel
M
M
Braun
P
P
May
E
E
Hetzer
R
R
Heinrich
K W
KW
D000328:Adult; D000450:Aldosterone / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000097:blood; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography / Q000187:drug effects*; D017335:Enoximone / Q000008:administration & dosage* / Q000009:adverse effects; D004837:Epinephrine / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation / Q000502:physiology*; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006728:Hormones / Q000097:blood*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000503:physiopathology; D009638:Norepinephrine / Q000097:blood*; D012083:Renin / Q000097:blood; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology
D006728:Hormones; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D017335:Enoximone; D012083:Renin; D009638:Norepinephrine; D004837:Epinephrine