Background: Intermittent dobutamine infusions(IDI) combined with oral amiodarone improve the survival of patients with end-stage congestive heart failure(CHF). The purpose of the present study was to evaluate whether ...Background: Intermittent dobutamine infusions(IDI) combined with oral amiodarone improve the survival of patients with end-stage congestive heart failure(CHF). The purpose of the present study was to evaluate whether the response to longterm treatment with IDI + amiodarone is different in patients with ischemic heart disease(IHD) versus idiopathic dilated cardiomyopathy(IDC).Methods: The prospective study population consisted of 21 patients with IHD(the IHD Group) and 16 patients with IDC(the IDC Group) who presented with decompensated CHF despite optimal medical therapy, and were successfully weaned from an initial 72-h infusion of dobutamine. They were placed on a regimen of oral amiodarone, 400 mg/day and weekly IDI, 10 μ g/kg/min, for 8 h. Results: There were no differences in baseline clinical and hemodynamic characteristics between the 2 groups. The probability of 2-year survival was 44% in the IDC Group versus 5% in the IHD Group(long-rank, P=0.004). Patients with IDC had a 77% relative risk reduction in death from all causes compared to patients with IHD(odd ratio 0.27, 95% confidence interval 0.13 to 0.70, P=0.007). In contrast, no underlying disease-related difference in outcomes was observed in a retrospectively analyzed historical Comparison Group of 29 patients with end stage CHF treated by standard methods. Conclusions: Patients with end stage CHF due to IDC derived a greater survival benefit from IDI and oral amiodarone than patients with IHD.展开更多
Background: The aim of this study was to evaluate the longterm effect of combined intermittent dobutamine infusions(IDI) and oral amiodarone on reverse left ventricular(LV) remodeling and hemodynamics of patients with...Background: The aim of this study was to evaluate the longterm effect of combined intermittent dobutamine infusions(IDI) and oral amiodarone on reverse left ventricular(LV) remodeling and hemodynamics of patients with idiopathic dilated cardiomyopathy(IDC) and end-stage congestive heart failure(CHF). Methods: This non-randomized, prospective, clinical trial included sixteen consecutive patients suffering from dyspnea for a mean of 76± 43 months, who presented with acute cardiac decompensation and were weaned from dobutamine therapy after an initial 72-h infusion. They were then placed on a regimen of oral amiodarone, 400 mg/day and weekly IDI, 10 μ g/kg/min, for 8 h. The long-term clinical outcomes and the effects of treatment on reverse LV remodeling(echocardiographic parameters) and hemodynamics were evaluated at 3, 6, and 12 months of follow up. Results: A significant degree of reverse LV remodeling, hemodynamic improvements, and survivals >1.5 years were observed in 9 of the 16 patients(56% ). In addition, 5 patients(31% of entire cohort) were weaned from IDI after a mean of 61± 41 weeks, and 4 remained clinically stable for 116± 66 weeks thereafter. At 12 months of follow-up, LV end-diastolic and end-systolic volume indices had decreased from 231± 91 to 206± 80 ml/m2(P=0.002) and from 137± 65 to 110± 50 ml/m2(P=0.003), respectively, right atrial pressure from 16± 6 to 5.6± 4 mm Hg,(P=0.031), and pulmonary capillary wedge pressure from 29± 4 to 16± 5.4 mm Hg, P=0.000, while LV ejection fraction had increased from 22± 6% to 27.3± 8% (P=0.006). Conclusions: In end-stage CHF due to IDC, long-term treatment with IDI and oral amiodarone caused reverse LV remodeling, and allowed permanent and successful weaning from IDI in 1 / 4 of patients.展开更多
文摘Background: Intermittent dobutamine infusions(IDI) combined with oral amiodarone improve the survival of patients with end-stage congestive heart failure(CHF). The purpose of the present study was to evaluate whether the response to longterm treatment with IDI + amiodarone is different in patients with ischemic heart disease(IHD) versus idiopathic dilated cardiomyopathy(IDC).Methods: The prospective study population consisted of 21 patients with IHD(the IHD Group) and 16 patients with IDC(the IDC Group) who presented with decompensated CHF despite optimal medical therapy, and were successfully weaned from an initial 72-h infusion of dobutamine. They were placed on a regimen of oral amiodarone, 400 mg/day and weekly IDI, 10 μ g/kg/min, for 8 h. Results: There were no differences in baseline clinical and hemodynamic characteristics between the 2 groups. The probability of 2-year survival was 44% in the IDC Group versus 5% in the IHD Group(long-rank, P=0.004). Patients with IDC had a 77% relative risk reduction in death from all causes compared to patients with IHD(odd ratio 0.27, 95% confidence interval 0.13 to 0.70, P=0.007). In contrast, no underlying disease-related difference in outcomes was observed in a retrospectively analyzed historical Comparison Group of 29 patients with end stage CHF treated by standard methods. Conclusions: Patients with end stage CHF due to IDC derived a greater survival benefit from IDI and oral amiodarone than patients with IHD.
文摘Background: The aim of this study was to evaluate the longterm effect of combined intermittent dobutamine infusions(IDI) and oral amiodarone on reverse left ventricular(LV) remodeling and hemodynamics of patients with idiopathic dilated cardiomyopathy(IDC) and end-stage congestive heart failure(CHF). Methods: This non-randomized, prospective, clinical trial included sixteen consecutive patients suffering from dyspnea for a mean of 76± 43 months, who presented with acute cardiac decompensation and were weaned from dobutamine therapy after an initial 72-h infusion. They were then placed on a regimen of oral amiodarone, 400 mg/day and weekly IDI, 10 μ g/kg/min, for 8 h. The long-term clinical outcomes and the effects of treatment on reverse LV remodeling(echocardiographic parameters) and hemodynamics were evaluated at 3, 6, and 12 months of follow up. Results: A significant degree of reverse LV remodeling, hemodynamic improvements, and survivals >1.5 years were observed in 9 of the 16 patients(56% ). In addition, 5 patients(31% of entire cohort) were weaned from IDI after a mean of 61± 41 weeks, and 4 remained clinically stable for 116± 66 weeks thereafter. At 12 months of follow-up, LV end-diastolic and end-systolic volume indices had decreased from 231± 91 to 206± 80 ml/m2(P=0.002) and from 137± 65 to 110± 50 ml/m2(P=0.003), respectively, right atrial pressure from 16± 6 to 5.6± 4 mm Hg,(P=0.031), and pulmonary capillary wedge pressure from 29± 4 to 16± 5.4 mm Hg, P=0.000, while LV ejection fraction had increased from 22± 6% to 27.3± 8% (P=0.006). Conclusions: In end-stage CHF due to IDC, long-term treatment with IDI and oral amiodarone caused reverse LV remodeling, and allowed permanent and successful weaning from IDI in 1 / 4 of patients.
