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Long-term treatment with oral enoximone for chronic congestive heart failure: the European experience
Insights
Enoximone improved heart function in patients with chronic congestive heart failure, showing sustained clinical benefits and increased exercise capacity over 40 weeks. While some deaths occurred, most patients experienced improved New York Heart Association class and enhanced cardiac performance.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic congestive heart failure (CHF) significantly impacts patient quality of life and prognosis.
- Inotropic agents are crucial for managing CHF symptoms and improving cardiac function.
Purpose of the Study:
- To evaluate the long-term safety and efficacy of enoximone in patients with chronic congestive heart failure (CHF).
Main Methods:
- A study involving 30 patients (NYHA classes II-IV) with CHF (dilated cardiomyopathy or ischemic heart disease) receiving enoximone (50-100 mg TID).
- Cardiac function was assessed over a mean follow-up of 40 weeks using physical examination, exercise testing, echocardiography, and radionuclide angiography.
- Patients were on maintenance digitalis and diuretics therapy.
Main Results:
- Enoximone treatment led to improved New York Heart Association (NYHA) class in 18 patients and increased exercise capacity.
- Echocardiographic fractional shortening significantly increased (14% to 21%), and the preejection period/left ventricular ejection time ratio decreased (0.74 to 0.43, p<0.05).
- Radionuclide ejection fraction showed a non-significant increase from 23% to 27%.
Conclusions:
- Enoximone demonstrates sustained clinical improvement and enhanced cardiac function in patients with chronic heart failure over long-term treatment.
- While mortality occurred, the drug improved functional capacity and cardiac performance metrics in the majority of patients.
- Enoximone represents a viable therapeutic option for managing chronic congestive heart failure.
Abstract:
The long-term safety and efficacy of the inotropic/vasodilatory agent enoximone (50 to 100 mg 3 times daily) were evaluated in 30 patients with chronic congestive heart failure (New York Heart Association classes II to IV). Nineteen patients had idiopathic dilated cardiomyopathy and 11 had ischemic heart disease. Patients were receiving maintenance therapy of digitalis and diuretics. Cardiac function was assessed at 12 week intervals (physical examination, exercise testing, chest x ray, echocardiography, radionuclide angiography, 24-hour Holter monitoring and blood chemistry). During a mean follow-up of 40 weeks, 6 patients died, due to noncardiac (n = 1) and sudden death (n = 1) and to cardiac failure (n = 4) within 36 weeks of drug treatment. In the remaining patients New York Heart Association class improved in 18, was stationary in 5 and deteriorated in 1. Exercise capacity increased during the first 26 weeks and was maintained improved thereafter. Clinical improvement appeared not to wane with time. No change in heart rate, blood pressure and cardiothoracic ratio was observed. Echocardiographic left ventricular dimensions did not change significantly; however, the fractional shortening increased from baseline (14%) to 19% after 12 weeks, 17% after 26 weeks and 21% after 52 weeks (p less than 0.05). The preejection period/left ventricular ejection time ratio decreased from 0.74 to 0.35, 0.44 and 0.43 (p less than 0.05), respectively. There was an increase in radionuclide ejection fraction from 23% to 27% (difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)