May 16, 2026Journal of the American College of Cardiology
Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure
Key result
Carvedilol and metoprolol linked to blunted dobutamine hemodynamics in CHF, whereas enoximone response remains intact.
- n=29
Why the study?
Patients with HF on beta-blocker therapy may require inotropic hemodynamic support, but the hemodynamic response may be influenced by both the inotropic agent and the beta-blocker used.
Does long-term beta-blocker therapy influence the hemodynamic response to dobutamine and enoximone in patients with chronic heart failure?
Population
29 patients with chronic HF
Comparison
Dobutamine vs enoximone before and after treatment with metoprolol or carvedilol
Design
Hemodynamic study before and after beta-blocker therapy
Follow-up
9 to 12 months
Authors
Discussion
Loading...
Member takes
Implication
Carvedilol may blunt dobutamine's hemodynamic response in HF; leaves open whether enoximone is preferable during beta-blocker therapy.
Key Points
- This study aims to compare the hemodynamic effects of dobutamine and enoximone in patients receiving long-term beta-blocker therapy for chronic heart failure.
- Evaluated the hemodynamic effects using pulmonary artery catheterization in 29 patients with chronic heart failure.
- Administered dobutamine (5 to 20 microg/kg/min) and enoximone (0.5 to 2 mg/kg) before and after 9 to 12 months of beta-blocker treatment.
- Conducted hemodynamic studies after a wash-out period of >12 hours from all cardiovascular medications except beta-blockers.
- Metoprolol decreased mean pulmonary artery pressure and pulmonary wedge pressure during dobutamine infusion and increased cardiac index with enoximone.
- Carvedilol abolished increases in heart rate and stroke volume during dobutamine administration but maintained hemodynamic response to enoximone.
- Overall, carvedilol and metoprolol may inhibit the hemodynamic response to dobutamine without affecting enoximone response.
Study Design
Type
Observational (n=29)
Structured PICO
Does long-term beta-blocker therapy influence the hemodynamic response to dobutamine and enoximone in patients with chronic heart failure?
P
Population
29 patients with chronic heart failure
I
Intervention
Long-term beta-blocker therapy with metoprolol or carvedilol at standard target maintenance oral doses for 9 to 12 months
C
Comparator
Baseline (before beta-blocker therapy)
O
Outcome
Hemodynamic effects (including pulmonary artery pressure, pulmonary wedge pressure, cardiac index, stroke volume index, heart rate, systemic vascular resistance, and pulmonary vascular resistance) of dobutamine (5 to 20 microg/kg/min intravenously) and enoximone (0.5 to 2 mg/kg intravenously) assessed by pulmonary artery catheterizationsurrogate
In patients with chronic heart failure, carvedilol significantly inhibits the favorable hemodynamic response to dobutamine but not to enoximone, suggesting enoximone may be the preferred inotrope for patients on long-term carvedilol therapy.
Cite This Study
Metra et al. (2002) conducted an observational in chronic heart failure (HF) (n=29). Dobutamine and enoximone vs. Before beta-blocker therapy (metoprolol or carvedilol) was evaluated on Hemodynamic effects (pulmonary artery pressure, pulmonary wedge pressure, cardiac index, stroke volume index). Carvedilol and metoprolol significantly inhibited the favorable hemodynamic response to dobutamine in patients with chronic heart failure, whereas the response to enoximone was maintained or enhanced.