Intracoronary infusion of dobutamine to patients with and without severe congestive heart failure. Dose-response relationships, correlation with circulating catecholamines, and effect of phosphodiesterase inhibition.
Key result
Intracoronary dobutamine produced a maximal inotropic response in patients with severe congestive heart failure that was only 37% of that in normal subjects.
Why the study?
Does intracoronary dobutamine elicit a different inotropic response in severe CHF patients compared to normal subjects, and is this response modified by milrinone?
Population
24 patients with severe congestive heart failure and 8 normal subjects without hemodynamic dysfunction.
Comparison
Intracoronary infusion of dobutamine into the… vs Normal subjects without hemodynamic dysfunction…
Design
Other
Authors
Discussion
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Implication
Reduced dobutamine inotropy in severe HF suggests clinical caution; leaves open whether milrinone pretreatment augments response.
Study Design
Type
Observational (n=32)
Multicenter
No
Structured PICO
Does intracoronary dobutamine elicit a different inotropic response in severe CHF patients compared to normal subjects, and is this response modified by milrinone?
P
Population
24 patients with severe congestive heart failure (CHF) and 8 normal subjects without hemodynamic dysfunction (total n=32).
I
Intervention
Intracoronary (IC) infusion of dobutamine into the left main coronary artery. A subset of 9 CHF patients also received IC milrinone followed by a second IC dobutamine infusion.
C
Comparator
Normal subjects without hemodynamic dysfunction (for baseline response comparison) and within-subject comparison (before vs. after milrinone).
O
Outcome
Maximal +dP/dt response to intracoronary dobutamine.surrogate
Main Result
Absolute Event Rate: 528% vs 1437%
p-value: p=<0.01
The inotropic response to dobutamine is markedly blunted in severe heart failure but can be significantly enhanced by pretreatment with the phosphodiesterase inhibitor milrinone.
Limitations
- Maximal dobutamine infusion rates could not be routinely achieved in normal subjects due to palpitations and tachycardia.
- The study did not assess the effect of dobutamine on left ventricular volume, so drug-induced changes in preload contributing to +dP/dt changes cannot be excluded.
- Small sample size.
Cite This Study
Colucci et al. (1988) conducted an observational in Severe congestive heart failure (n=32). Intracoronary dobutamine vs. Normal subjects was evaluated on Peak increase in left ventricular +dP/dt (p=<0.01). Intracoronary dobutamine produced a maximal inotropic response in patients with severe congestive heart failure that was only 37% of that in normal subjects.