What is the clinical evidence from this study?

Population: Chronic heart failure (n=10). Intervention: Pimobendan vs. Captopril 12.5 mg orally. Primary outcome: Systemic vascular resistance (SVR) at 2 hours (dyne·sec·cm-5) (p=<0.01).

January 1, 1992Japanese Heart JournalOpen Access

Acute Hemodynamics of Pimobendan in Chronic Heart Failure. a Comparative Crossover Study of Captopril and Pimobendan.

Q: What are the key findings of this study?

Intravenous pimobendan acted as a stronger arterio-venodilator than oral captopril, producing marked pulmonary and venous dilation in addition to comparable systemic vasodilation in patients with chronic heart failure.

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Key result

Intravenous pimobendan acted as a stronger arterio-venodilator than oral captopril, producing marked pulmonary and venous dilation in addition to comparable systemic vasodilation in patients with chronic heart failure.

Why the study?

Does pimobendan improve acute hemodynamics compared to captopril in patients with chronic heart failure?

Population

10 patients with chronic heart failure, mean age 62.5 years, 90% male. 5 patients had dilated cardiomyopathy…

Comparison

Pimobendan 2.5 mg intravenous bolus vs Captopril 12.5 mg orally

Follow-up

6 hours

Authors

TTTakashi TsudaSt. Marianna University School of Medicine TITohru IzumiNiigata Prefectural Niigata Minami High School MKMakoto KodamaKanazawa University

Discussion

Member takes

Implication

May support acute IV use in chronic HF; leaves open outcome trials before practice change.

Structured PICO

Does pimobendan improve acute hemodynamics compared to captopril in patients with chronic heart failure?

Population

10 patients (mean age 62, 10% female) with chronic heart failure (NYHA II-III) stabilized on diuretics and digitalis, evaluated for acute hemodynamic responses over 6 hours.

Intervention

Pimobendan 2.5 mg intravenous bolus

Comparator

Captopril 12.5 mg orally (administered in a fixed-sequence crossover design prior to pimobendan)

Outcome

Acute hemodynamic changes including mean pulmonary artery pressure, total pulmonary resistance, mean arterial pressure, systemic vascular resistance, and mean right atrial pressure measured serially via Swan-Ganz catheter up to 6 hourssurrogate

Main Result

Absolute Event Rate: 1884% vs 2200%

p-value: p=<0.01

In patients with chronic heart failure, intravenous pimobendan acts as a stronger arterio-venodilator than oral captopril, producing marked pulmonary arteriovasodilating and venodilating effects.

Limitations

Small sample size (n=10)
Fixed sequence of drug administration without randomization (captopril first, then pimobendan)
Baseline mean arterial pressure was significantly lower prior to pimobendan than before captopril
Short-term acute observation period (up to 6 hours) does not reflect long-term maximal hemodynamic responses
Small sample size
Patients had only slightly elevated systemic vascular resistance at baseline
Marked decrease in left ventricular preload may have counteracted the inotropic effect
Baseline mean arterial pressure was significantly lower prior to pimobendan than before captopril, potentially underestimating pimobendan's arteriovasodilating effect

Cite This Study

Tsuda et al. (1992) studied Chronic heart failure (n=10). Pimobendan vs. Captopril 12.5 mg orally was evaluated on Systemic vascular resistance (SVR) at 2 hours (dyne·sec·cm-5) (p=<0.01). Intravenous pimobendan acted as a stronger arterio-venodilator than oral captopril, producing marked pulmonary and venous dilation in addition to comparable systemic vasodilation in patients with chronic heart failure.

synapsesocial.com/papers/6a978ead6ccf0d1eee31c58f https://doi.org/10.1536/ihj.33.193

Topics

Heart failure HFrEF treatment

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Acute Hemodynamics of Pimobendan in Chronic Heart Failure. a Comparative Crossover Study of Captopril and Pimobendan.

Discussion

Member takes

Implication

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Acute Hemodynamics of Pimobendan in Chronic Heart Failure. a Comparative Crossover Study of Captopril and Pimobendan.

Discussion

Member takes

Implication

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider