| Autor: |
Lee, Howard R., Hershberger, Ray E., David Port, J., Rasmussen, Randy, Renlund, Dale G., O’Connell, John B., Gilbert, Edward M., Mealey, Patrice C., Volkman, Kirk, Menlove, Ronald, Bristow, Michael R. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; August 1991, Vol. 102 Issue: 2 p246-258, 13p |
| Abstrakt: |
During a 3-year period we administered enoximone, a phosphodiesterase inhibitor with positive inotropic and vasodilator properties, to 73 pretransplantation patients with end-stage heart failure who exhibited a clinical requirement for additional inotropic support. The clinical course and myocardial β-adrenergic receptor status in the explanted hearts of these 73 patients was compared with results in 113 concurrently listed pretransplantation patients not requiring additional inotropic support. Only three patients required cessation of enoximone because of adverse effects, all from exacerbation of ventricular arrhythmias. Sixty-six of the 73 (90.4%) enoximone-treated patients ultimately underwent cardiac transplantation a mean of 39.2 ± 6.6 days (range 1 to 221 days) after starting enoximone, whereas seven patients (9.6%) died awaiting cardiac transplantation. The respective 1-, 3-, and 6-month pretransplantation survival rates of patients treated with enoximone calculated from their time on the waiting list for transplantation were 88.0%, 82.5%, and 82.5% compared with 92.1%, 83.8%, and 76.2% in control patients not receiving enoximone (all p = not significant). In 25 patients who received enoximone, ventricular myocardial β-adrenergic receptors were measured at the time of transplantation and compared with values in failing ventricles from 52 pretransplantation patients not exposed to enoximone. Compared with ventricular myocardium of patients not given enoximone or intravenous β-adrenergic agonists, total β-adrenergic receptor (β1plus β2) density was not decreased in patients treated with enoximone or enoximone plus intravenous β-adrenergic agonists, but was decreased by 31 % (p < 0.05) in patients given intravenous β-adrenergic agonists alone. Additionally, patients treated with enoximone had higher myocardial β2-adrenergic receptor densities than respective subgroups treated without (28% higher, p <0.01) or with (65% higher, p < 0.01) intravenous β-adrenergic agonists. Finally, isoproterenol- or calcium-mediated contractile responses in isolated right ventricular preparations from 14 patients treated with enoximone were similar to values in control patients not exposed to enoximone or intravenous β-adrenergic agonists, suggesting that enoximone-related β-adrenergic subsensitivity or damage to the contractile apparatus does not occur. |
| Databáze: |
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