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Enoximone echocardiography: a novel test to evaluate left ventricular contractile reserve in patients with heart failure on chronic beta-blocker therapy.

Ghio S, Constantin C, Raineri C, Fontana A, Klersy C, Campana C, Tavazzi L - Cardiovasc Ultrasound (2003)

Bottom Line: Enoximone is a positive inotropic agent that inhibits cyclic adenosine monophosphate-specific phosphosdiesterase.Regional peak systolic velocities were evaluated by means of tissue Doppler imaging in four basal and four medium level segments.Dobutamine induced non-sustained ventricular tachycardia in three patients and supraventricular tachycardia in one, whereas enoximone did not induce any repetitive arrhythmias.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy. s.ghio@smatteo.pv.it

ABSTRACT

Background: It has been suggested that an extensive contractile reserve identified recognised by means of dobutamine stress echocardiography may predict a better prognosis in patients with severe left ventricular dysfunction at rest. However, the clinical use of dobutamine stress echocardiography may be limited in patients with chronic heart failure by the substantial proportion of such patients treated with beta-blockers, since the inotropic response to adrenergic stimulation is known to be attenuated in patients receiving beta-adrenoceptor blockers. Enoximone is a positive inotropic agent that inhibits cyclic adenosine monophosphate-specific phosphosdiesterase. We therefore tested the hypothesis that enoximone may be an alternative to dobutamine in evaluating left ventricular contractile reserve in patients with systolic dysfunction on chronic beta-blocker therapy.

Methods: We studied 26 patients (21 males and five females) with a mean age of 58 PlusMinus; 10 years: 11 were not receiving beta-blockers (noBB group); 15 were receiving carvedilol at a mean dose of 34 mg/day (BB group). Dobutamine was infused at doses of 5 and 10 micrograms/kg/min, and enoximone at a dose of 1.5 mg/kg.

Results: The ejection fraction in the noBB group increased by 9% with dobutamine and 8.73% with enoximone (p = 0.86); in the BB group, it increased by 6% with dobutamine and 8.94% with enoximone (p = 0.03). Regional peak systolic velocities were evaluated by means of tissue Doppler imaging in four basal and four medium level segments. In the noBB group, they increased more with dobutamine than with enoximone in three of the eight segments; no significant differences were found in the BB group. Dobutamine induced non-sustained ventricular tachycardia in three patients and supraventricular tachycardia in one, whereas enoximone did not induce any repetitive arrhythmias.

Conclusions: Enoximone might be preferable to low-dose dobutamine for evaluating left ventricular contractile reserve in chronically beta-blocked heart failure patients as it is slightly more potent and has a better safety profile.

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Related in: MedlinePlus

Changes in blood pressure (BP delta) and in heart rate (HR delta) in non beta-blocked patients, during enoximone and dobutamine stress test.
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Figure 2: Changes in blood pressure (BP delta) and in heart rate (HR delta) in non beta-blocked patients, during enoximone and dobutamine stress test.

Mentions: The data are shown as mean values ± SD for continuous variables, and absolute or relative frequencies for categorical variables. The mean group values were compared using the unpaired t test, and the test results within each group by means of the paired t test. A 2-sided p value of <0.05 was considered statistically significant. The computations were made using Stata 7 software (Stata Corp, College Station, TX).


Enoximone echocardiography: a novel test to evaluate left ventricular contractile reserve in patients with heart failure on chronic beta-blocker therapy.

Ghio S, Constantin C, Raineri C, Fontana A, Klersy C, Campana C, Tavazzi L - Cardiovasc Ultrasound (2003)

Changes in blood pressure (BP delta) and in heart rate (HR delta) in non beta-blocked patients, during enoximone and dobutamine stress test.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC240109&req=5

Figure 2: Changes in blood pressure (BP delta) and in heart rate (HR delta) in non beta-blocked patients, during enoximone and dobutamine stress test.
Mentions: The data are shown as mean values ± SD for continuous variables, and absolute or relative frequencies for categorical variables. The mean group values were compared using the unpaired t test, and the test results within each group by means of the paired t test. A 2-sided p value of <0.05 was considered statistically significant. The computations were made using Stata 7 software (Stata Corp, College Station, TX).

Bottom Line: Enoximone is a positive inotropic agent that inhibits cyclic adenosine monophosphate-specific phosphosdiesterase.Regional peak systolic velocities were evaluated by means of tissue Doppler imaging in four basal and four medium level segments.Dobutamine induced non-sustained ventricular tachycardia in three patients and supraventricular tachycardia in one, whereas enoximone did not induce any repetitive arrhythmias.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy. s.ghio@smatteo.pv.it

ABSTRACT

Background: It has been suggested that an extensive contractile reserve identified recognised by means of dobutamine stress echocardiography may predict a better prognosis in patients with severe left ventricular dysfunction at rest. However, the clinical use of dobutamine stress echocardiography may be limited in patients with chronic heart failure by the substantial proportion of such patients treated with beta-blockers, since the inotropic response to adrenergic stimulation is known to be attenuated in patients receiving beta-adrenoceptor blockers. Enoximone is a positive inotropic agent that inhibits cyclic adenosine monophosphate-specific phosphosdiesterase. We therefore tested the hypothesis that enoximone may be an alternative to dobutamine in evaluating left ventricular contractile reserve in patients with systolic dysfunction on chronic beta-blocker therapy.

Methods: We studied 26 patients (21 males and five females) with a mean age of 58 PlusMinus; 10 years: 11 were not receiving beta-blockers (noBB group); 15 were receiving carvedilol at a mean dose of 34 mg/day (BB group). Dobutamine was infused at doses of 5 and 10 micrograms/kg/min, and enoximone at a dose of 1.5 mg/kg.

Results: The ejection fraction in the noBB group increased by 9% with dobutamine and 8.73% with enoximone (p = 0.86); in the BB group, it increased by 6% with dobutamine and 8.94% with enoximone (p = 0.03). Regional peak systolic velocities were evaluated by means of tissue Doppler imaging in four basal and four medium level segments. In the noBB group, they increased more with dobutamine than with enoximone in three of the eight segments; no significant differences were found in the BB group. Dobutamine induced non-sustained ventricular tachycardia in three patients and supraventricular tachycardia in one, whereas enoximone did not induce any repetitive arrhythmias.

Conclusions: Enoximone might be preferable to low-dose dobutamine for evaluating left ventricular contractile reserve in chronically beta-blocked heart failure patients as it is slightly more potent and has a better safety profile.

Show MeSH
Related in: MedlinePlus