A randomized comparison of intravenous amrinone versus dobutamine in older patients with decompensated congestive heart failure
| Autor: | Jane C. Sperry, Lynn Coulter, Patric J. Morello, Howard I. Kurz, Michael W. Rich, Valerie Beckham, Victor G. Davila-Roman, William L. Woods, Peggy A. Brown, Lisa R. Spinner, Rick A. Barbarash |
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| Rok vydání: | 1995 |
| Předmět: |
Inotrope
Male medicine.medical_specialty Cardiac index Ventricular Function Left Amrinone Double-Blind Method Internal medicine Dobutamine medicine Humans Decompensation Prospective Studies Infusions Intravenous Aged Aged 80 and over Heart Failure Analysis of Variance Ejection fraction business.industry Hemodynamics Stroke volume medicine.disease Treatment Outcome Anesthesia Heart failure Cardiology Female Geriatrics and Gerontology business medicine.drug |
| Zdroj: | Journal of the American Geriatrics Society. 43(3) |
| ISSN: | 0002-8614 |
| Popis: | To compare the hemodynamic effects of amrinone and dobutamine in patients 75 years of age or older who have severe congestive heart failure requiring invasive hemodynamic monitoring and inotropic support.Prospective, randomized, double-blind clinical trial.Coronary care unit of a university teaching hospital.Fourteen patientsor = 75 years of age (mean 80.3 +/- 5.7 years) with refractory New York Heart Association class IV congestive heart failure. All patients had a cardiac index2.5 L/min/M2 (mean 1.8 +/- 0.3 L/min/M2), pulmonary capillary wedge pressureor = 18 mm Hg (mean 26 +/- 10 mm Hg), and left ventricular ejection fraction40% (mean 26 +/- 10%).Patients were randomly assigned to treatment with 2-hour infusions of amrinone (n = 7) or dobutamine (n = 7) at fixed dosages of 5 and 10 micrograms/kg/min.Complete hemodynamic data were obtained at baseline and after each 2-hour medication infusion. Transthoracic two-dimensional echocardiography was performed at baseline and after the 10 micrograms/kg/min medication dose. The primary analysis compared the effects of the two drugs on cardiac index and stroke volume index at each of the two dosages.Both amrinone and dobutamine had salutary hemodynamic effects, as indicated by improvements in cardiac index, stroke volume index, pulmonary capillary wedge pressure, and systemic vascular resistance (all P.05 except effect of amrinone on stroke index and wedge pressure). Although the overall hemodynamic effects of amrinone and dobutamine were similar, stroke volume index was higher with dobutamine at the 10 micrograms/kg/min dose (35 +/- 7 ml/M2 vs 26 +/- 6 mL/M2; P = .045). Two dobutamine patients were withdrawn from the study after the 5 micrograms/kg/min dose due to adverse effects (tachycardia, increased ventricular ectopy). One additional patient in each group was noted to have ventricular arrhythmias not requiring termination of the protocol.Both amrinone and dobutamine are efficacious in improving hemodynamics in older patients with severe congestive heart failure caused by left ventricular contractile dysfunction. Despite the effect of aging on beta-adrenergic responsiveness, dobutamine is at least as effective as amrinone but may be associated with a higher incidence of arrhythmic side effects. |
| Databáze: | OpenAIRE |
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