PMID- 11288970
OWN - NLM
STAT- MEDLINE
DCOM- 20010726
LR  - 20200225
IS  - 0160-9289 (Print)
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 24
IP  - 3
DP  - 2001 Mar
TI  - Dobutamine as bridge to angiotensin-converting enzyme inhibitor-nitrate therapy 
      in endstage heart failure.
PG  - 231-6
AB  - BACKGROUND: Intravenous inotropic intervention in congestive heart failure is 
      generally associated with a poor prognosis and is largely used as a "bridge" to 
      mechanical support or heart transplantation. HYPOTHESIS: We hypothesized that the 
      inotropic support afforded by dobutamine may serve as a bridge to the 
      introduction and intensification of angiotensin-converting enzyme (ACE) 
      inhibitor-nitrate therapy. METHODS: We studied the efficacy of transitioning 
      inotrope-dependent patients in endstage heart failure from intravenous dobutamine 
      to high-dose ACE inhibitor-nitrates, with 1-year follow-up. Forty-nine sequential 
      dobutamine-dependent patients with left ventricular ejection fraction (LVEF) 
      17+/-17% were treated with increasing lisinopril (1.9+/-1.5 to 46+/-28 mg/day) 
      and isosorbide dinitrate (7+/-6 to 229+/-161 mg/day). Outpatient dobutamine was 
      continued or repeat infusions pursued, as indicated, and dobutamine was tapered 
      when feasible. RESULTS: During the following year, 14 of 49 patients required 
      repeat dobutamine, with home treatment with dobutamine for 6.3+/-3.7 months (n = 
      5). At 1 year, New York Heart Association (NYHA) classification improved from 
      3.6+/-0.5 to 1.9+/-1.0, p < 0.0001; yearly hospitalizations fell from 2.7+/-2.3 
      to 1.2+/-3.0, p = 0.02; and LVEF rose from 17+/-7% to 24+/-11%, p < 0.0001. At 1 
      year, 14 patients who remained dobutamine dependent had significantly more severe 
      symptoms than dobutamine-independent patients (n = 35). Transplant or death 
      occurred in 7 of 14 patients with follow-up dobutamine, and in 5 of 35 patients 
      free of subsequent dobutamine, p = 0.03. Patients with poor outcome (transplant n 
      = 10, death n = 12) continued to be more limited (NYHA 2.7+/-0.9 vs. 1.7+/-0.9, p 
      = 0.0002), with more follow-up hospitalizations (3.6+/-5.4 vs. 0.6+/-0.8, p = 
      0.0004), and no improvement in LVEF (17+/-8vs. 28+/-11%, p = 0.003). CONCLUSIONS: 
      Of the patients on dobutamine inotropic support, 70% were successfully 
      transitioned to ACE inhibitor-nitrate therapy, with improved symptoms and LVEF, 
      and with reduced hospitalizations and follow-up dobutamine or transplant. Thirty 
      percent of patients with continued need for dobutamine had a significantly poorer 
      1-year clinical outcome.
FAU - Levine, T B
AU  - Levine TB
AD  - Michigan Institute for Heart Failure and Transplant Care, Botsford General 
      Hospital, Farmington Hills 48336, USA.
FAU - Levine, A B
AU  - Levine AB
FAU - Elliott, W G
AU  - Elliott WG
FAU - Narins, B
AU  - Narins B
FAU - Stomel, R J
AU  - Stomel RJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Vasodilator Agents)
RN  - 3S12J47372 (Dobutamine)
RN  - E7199S1YWR (Lisinopril)
RN  - IA7306519N (Isosorbide Dinitrate)
SB  - IM
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Cardiotonic Agents/*therapeutic use
MH  - Dobutamine/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Heart Failure/diagnostic imaging/*drug therapy/physiopathology
MH  - Humans
MH  - Isosorbide Dinitrate/*therapeutic use
MH  - Lisinopril/*therapeutic use
MH  - Prospective Studies
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ultrasonography
MH  - Vasodilator Agents/*therapeutic use
PMC - PMC6654832
EDAT- 2001/04/06 10:00
MHDA- 2001/07/31 10:01
PMCR- 2009/02/03
CRDT- 2001/04/06 10:00
PHST- 2001/04/06 10:00 [pubmed]
PHST- 2001/07/31 10:01 [medline]
PHST- 2001/04/06 10:00 [entrez]
PHST- 2009/02/03 00:00 [pmc-release]
AID - CLC4960240311 [pii]
AID - 10.1002/clc.4960240311 [doi]
PST - ppublish
SO  - Clin Cardiol. 2001 Mar;24(3):231-6. doi: 10.1002/clc.4960240311.