Comparison of acute hemodynamic response to dobutamine and intravenous MDL 17,043 (enoximone) in severe congestive heart failure secondary to ischemic cardiomyopathy or idiopathic dilated cardiomyopathy

Abstract

The acute hemodynamic response to intravenous dobutamine administration was compared with intravenous MDL 17,043 administration in 8 patients with severe, chronic congestive heart failure. Simultaneous radionuclide angiography was performed with gated equilibrium blood pool imaging to derive left ventricular volumes and ejection fraction during serial hemodynamic measurements. Six patients had an optimal dobutamine dose of 10 μg/kg/min; 2 others were compared at a dose of 7.5 μg/kg/ min; comparisons with MDL 17,043 were after a 1.5-mg/kg bolus dose in all 8 patients. Dobutamine and MDL 17,043 caused significant and similar increases in cardiac index and stroke volume index. Dobutamine significantly increased heart rate and MDL 17,043 did not. MDL 17,043 significantly decreased pulmonary artery wedge, mean pulmonary artery and right atrial pressures; dobutamine did not. Dobutamine increased end-diastolic volume in 4 patients, with little concomitant decrease in wedge pressure; MDL 17,043 caused no change or a decrease in left ventricular end-diastolic volume in 5 patients, but consistently decreased wedge pressure in all. Thus, the left ventricular pressure-volume curve was displaced downward to a more favorable position after MDL 17,043 but not after dobutamine. In patients with chronic congestive heart failure, acute myocardial performance was more optimally influenced by MDL 17,043 than dobutamine administration.