title: Double-blind placebo-controlled comparison of enoximone and dobutamine infusions in patients with moderate to severe chronic heart failure.
abstract: Few data exist on the safety of transferring patients to standard oral therapy for chronic heart failure (CHF) after acute management with inotropic agents. This study compares hemodynamic responses and cardiac dysrhythmic effects of continuous infusion of enoximone, dobutamine, or placebo in patients with moderate to severe CHF. The authors enrolled 136 patients who were randomly assigned to either open-label dobutamine or double-blind enoximone vs placebo. After 24 hours of treatment, the study was unblinded. Patients receiving placebo completed the study. Patients receiving enoximone or dobutamine received the infusion for an additional 24 hours and were then switched to standard oral therapy for 72 hours. Compared with placebo, both enoximone and dobutamine increased cardiac index and decreased pulmonary capillary wedge pressure (PCWP). Compared with dobutamine, enoximone significantly increased cardiac index after the first 24 hours of infusion and significantly decreased PCWP throughout the infusion period. There was no difference in the incidence of arrhythmias between enoximone and dobutamine. More patients (65%) tolerated the switch to oral therapy in the enoximone group compared with dobutamine (49%; P =.12). Enoximone is effective in improving the hemodynamics in patients with moderate to severe CHF and is tolerated at least as well as dobutamine.
authors.affiliation: Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA. feras.bader@hsc.utah.edu
authors.forename: Feras M
authors.initials: FM
authors.lastname: Bader
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: Neal A
authors.initials: NA
authors.lastname: Mehta
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bristow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003326:Coronary Circulation; D017868:Cyclic AMP-Dependent Protein Kinases; D017869:Cyclic GMP-Dependent Protein Kinases; D018450:Disease Progression; D004280:Dobutamine / Q000627:therapeutic use*; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D017335:Enoximone / Q000627:therapeutic use*; D005260:Female; D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D013223:Statistics as Topic; D013318:Stroke Volume; D013566:Sympathomimetics / Q000627:therapeutic use*; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D013566:Sympathomimetics; D004280:Dobutamine; D017335:Enoximone; D017868:Cyclic AMP-Dependent Protein Kinases; D017869:Cyclic GMP-Dependent Protein Kinases