Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Sep 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Arrhythmia in patients with low cardiac output after valvular surgery. Randomized, double-blind comparative study of dobutamine versus enoximone].
Forty patients with low cardiac output (cardiac index less than 2.2 l/mn/m2 and pulmonary wedge pressure greater than 15 mmHg) after valvular surgery were randomised into two groups. Patients in Group 1 were given 5 to 10 micrograms/Kg/mn of Dobutamine (D) and those In Group 2 a bolus of Enoximone (E) 1 mg/kg followed by an intravenous infusion of 5 to 10 micrograms/Kg/mn. Holter ECG monitoring over 42.65 +/- 6.02 hrs (24-48 hours) was obtained and interpreted blindly in 37/40 patients (19 Group D and 18 Group E). ⋯ No deaths occurred during the protocol period. The total duration of inotropic therapy (86 +/- 49 hours) and the period spent in the intensive care unit (155 +/- 129 hours) were longer in Group D than in Group E (60 +/- 23 hrs and 92 +/- 37 hrs, respectively; p less than .05). Antiarrhythmic therapy was used more often in Group D (4 patients) than in group E (1 patient) (p = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Mal Coeur Vaiss · Sep 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Enoximone/dobutamine comparison in chronic congestive cardiac insufficiency with low cardiac output].
In severe chronic congestive cardiac failure the physician has the choice of two families of positive inotropic agents, the direct sympathomimetics and the phosphodiesterase inhibitors. The aim of the study was to compare the efficacy and tolerance of enoximone and dobutamine in this indication. Twenty patients with severe chronic cardiac failure with a cardiac index of less than 2.2 l/min/m2 and pulmonary capillary pressure of over 20 mmHg were randomised into two groups in an open trial. ⋯ The cardiac index increased with enoximone (+61.0%, p less than 0.01) and with dobutamine (+32.1%, p less than 0.02). This resulted mainly from an increase in the systolic index (+45.5%, p less than 0.05 with enoximone and +30.1%, p less than 0.05 with dobutamine). Pulmonary capillary pressure and total systemic resistance decreased with enoximone (-29.1%, p less than 0.001 and -36.7%, p less than 0.05 respectively) and with dobutamine (-23.4%, p less than 0.001 and -20.7%, p less than 0.05 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Mal Coeur Vaiss · Sep 1990
Comparative Study Clinical Trial[Hemodynamic effects of enoximone and comparison with dobutamine in patients with chronic respiratory insufficiency and pulmonary arterial hypertension].
The aim of this study was to assess the effects of enoximone on the right ventricle and pulmonary hypertension in 10 patients (53 to 84 years) with chronic obstructive airway disease resulting in acute or chronic respiratory failure requiring mechanical ventilation in 9 cases. These effects were compared with those of dobutamine. All patients were in sinus rhythm and 6 had signs of right ventricular failure. ⋯ The results (x +/- SD) were studied by a 2 factor variance analysis and compared by Student's test with Dunnett's correction. Cardiac index increased similarly by about 45% with enoximone (2.8 +/- 0.8 vs 4.1 +/- 1 l/min/m2; p less than 0.001 at TE2) and dobutamine, although the heart rate did not change significantly. Systemic arterial resistance fell significantly with enoximone (31.3 +/- 11 vs 21.3 +/- 6.8 IU; p less than 0.05 at TE2) but mean arterial pressures were unchanged; mean pulmonary artery pressures decreased from TE1 to TE3 (27.6 +/- 6.9 vs 22.6 +/- 6.3 mmHg; p less than 0.05 at TE2) mainly because pulmonary artery diastolic pressures decreased from TE1 to TE3 (20.1 +/- 4 vs 11.1 +/- 5.2 mmHg; p less than 0.05 at TE3).(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Mal Coeur Vaiss · Sep 1990
Comparative Study Clinical Trial Controlled Clinical Trial[Enoximone, vasodilator and/or inotropic agent in congestive cardiac insufficiency? Hemodynamic and ventriculographic study of 20 cases].
The aim of this study was to document the effects of enoximone in congestive cardiac failure. The haemodynamic data (aortic pressure, pulmonary pressures, left ventricular pressure, cardiac output, isovolumic contractility index: Vmax) and left ventricular kinetics of 20 patients with dilated cardiomyopathy (11 ischemic and 9 idiopathic in Stages III or IV of the NYHA Classification before recompensation) were recorded under basal conditions, after 30 minutes infusion of dobutamine (10 micrograms/kg/mn) and after 3 hours infusion of enoximone (total dose: 3.6 mg/kg). The two drugs had an equivalent inotropic effect: ejection fraction + 4 +/- 22% with dobutamine and + 16 +/- 39% with enoximone; Vmax increased from 1.53 +/- 0.5 c/sec to 2.49 +/- 0.8 c/sec with dobutamine and to 1.82 +/- 0.5 c/sec with enoximone. ⋯ Enoximone was less effective than dobutamine in increasing cardiac output (+ 46 +/- 42% with dobutamine and 16 +/- 33% with enoximone) and stroke volume (+ 23 +/- 47% with dobutamine and + 2 +/- 41% with enoximone). This difference in efficacy may be explained by the major reduction in ventricular preload which enoximone induced after that observed with dobutamine. "Responders" (12 patients) had basal cardiac outputs of less than 2.3 l/mn/m2; the peripheral vasodilatation caused by enoximone was greater. Finally, the reduction in left ventricular end diastolic pressure and the increase in Vmax were significantly less in the 11 patients with ischemic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Mal Coeur Vaiss · Sep 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of the hemodynamic effects of dobutamine and enoximone in the treatment of low cardiac output after valvular surgery].
Forty patients developed low cardiac output states after surgery for mitral valve disease or with associated cardiac disease and were randomly allocated to two treatment groups, one group to receive Dobutamine (D) and the other Enoximone (E), a phosphodiesterase inhibitor. Haemodynamic assessment covered a 24 hour period but treatment was continued for as long as was necessary. An improvement was observed from the 15th minute of treatment. ⋯ The duration of treatment was significantly shorter in Group E than in Group D (59 +/- 22 hrs vs 86 +/- 49 hrs) as was the patient's stay in the intensive care unit (92 +/- 37 hrs vs 155 +/- 129 hrs). The duration of assisted ventilation was the same in the two groups. These results suggest that Enoximone is as effective as Dobutamine in the treatment of low cardiac output after mitral valve surgery.(ABSTRACT TRUNCATED AT 250 WORDS)