Reverse left ventricular remodeling by intermittent dobutamine infusions and amiodarone in end-stage heart failure due to idiopathic dilated cardiomyopathy

Abstract

Background The aim of this study was to evaluate the long-term 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 μg/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/m 2 ( P = 0.002) and from 137 ± 65 to 110 ± 50 ml/m 2 ( 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.