title: Efficacy and limitations of oral inotropic agents for the treatment of chronic heart failure.
abstract: The heart failure guideline in Japan has stated the necessity of investigating the role of oral inotropic agents in patients with chronic heart failure (CHF), which are clinically available only in Japan. A total of 1,846 consecutive patients with heart failure (mean: 69.5 years old, 1,279 males) treated at our institute from November 2009 to August 2010 were investigated retrospectively. Thirty-one patients (1.84%) who had taken oral inotropic agents (pimobendan 27, docarpamine 6, and denopamine 4) were extracted for this study, and the efficacy and limitations of the treatments were analyzed. Following the oral inotropic treatment, the NYHA functional class (P = 0.017), cardiothoracic ratio (P = 0.002) and B-type natriuretic peptide levels (P = 0.011) were significantly improved, and the number of emergency room (ER) visits (P < 0.001) and hospitalizations (P < 0.001) were significantly reduced. The nonsurviving patients (n = 7/31, 22.6%) were significantly older (P = 0.02) and tended to have a larger cardiothoracic ratio (P = 0.084) compared with the survivors. An absence of concomitant beta-blocker therapy was significantly associated with a worse prognosis (oneyear mortality 2/21 versus 5/10, log rank, P = 0.011). Oral inotropic agents brought about improvements in the clinical parameters of CHF and a reduction in ER visits and hospitalizations. However, concomitant beta-blocker therapy should be considered for patients receiving oral inotropic treatment.
authors.affiliation: Department of Cardiology, Nippon Medical School Chiba-Hokusoh, Chiba, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Murai
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.forename: Nakahisa
authors.initials: N
authors.lastname: Kimata
authors.forename: Toru
authors.initials: T
authors.lastname: Inami
authors.forename: Daisuke
authors.initials: D
authors.lastname: Murakami
authors.forename: Junko
authors.initials: J
authors.lastname: Abe
authors.forename: Kenji
authors.initials: K
authors.lastname: Yodogawa
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Maruyama
authors.forename: Masamichi
authors.initials: M
authors.lastname: Takano
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohba
authors.forename: Chikao
authors.initials: C
authors.lastname: Ibuki
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D011724:Pyridazines; C041648:pimobendan