Hemodynamic effects of dobutamine in patients with an exacerbation of chronic systolic heart failure treated with low doses of carvedilol.
Although most patients in Europe with systolic heart failure (SHF) are treated with I(2)-blocking agents at doses significantly lower than the recommended dose, there is limited information available regarding the hemodynamic effects of dobutamine in this patient population. Therefore, a study was carried out in patients (n=31) admitted to the University Hospital, Larissa, Greece with an acute exacerbation of chronic SHF (25 men and 6 women, mean age 58 years, range 32 â 80 years, left ventricular (LV) ejection fraction <or= 0.35) and a systolic blood pressure between 85 and 110 mmHg. All patients underwent a complete echocardiographic/ Doppler examination before and immediately after a 24-hour intravenous dobutamine infusion (2.5-10 microg/kg/min). Of the patients admitted to the study, 22 (71%) had been treated by practicing physicians and the mean carvedilol dose at admission was 16+/-9 mg daily (6.25-50 mg daily). Dobutamine was associated with a small increase in LV ejection fraction (from 26.3+/-4.3% to 27.8+/-4.3%, p=0.005), a non-significant increase in heart rate (71.4+/-11 vs. 68+/-18 beats/min, p=0.19) and cardiac output (3.52+/-1 l/min vs. 3.74+/-1.06 l/min, p=0.14) and a significant decrease in the E-wave deceleration time (146.2+/-65 msec vs. 142.6+/-58.3 msec, p=0.04). Thus, in patients with SHF, treated with low doses of carvedilol, the favorable hemodynamic effects of dobutamine are blunted and alternative inotropic agents should be used.
Triposkiadis
F
F
Department of Cardiology, Larissa University Hospital, Larissa, Greece. ftriposkiadis@yahoo.com
Dalampiras
P
P
Kelepeshis
G
G
Skoularigis
J
J
Sitafidis
G
G
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000077261:Carvedilol; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D013318:Stroke Volume
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D002316:Cardiotonic Agents; D011412:Propanolamines; D000077261:Carvedilol; D004280:Dobutamine