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Comparative vasoactive therapy for heart failure.

J R Benotti, J E McCue, J S Alpert

    The American Journal of Cardiology
    |July 22, 1985
    PubMed
    Summary
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    Amrinone and dobutamine offer similar hemodynamic benefits for congestive heart failure (CHF) patients, improving cardiac index and reducing pulmonary artery wedge pressure. Dopamine was less tolerated due to adverse effects.

    Area of Science:

    • Cardiology
    • Pharmacology

    Background:

    • Dopamine and dobutamine are beta-adrenergic stimulants used for decompensating congestive heart failure (CHF).
    • Both agents can cause significant adverse effects.
    • Amrinone, a bipyridine derivative, was reported in 1981 to produce similar hemodynamic changes to dobutamine.

    Purpose of the Study:

    • To compare the hemodynamic and clinical effects of amrinone with dopamine and dobutamine in patients with CHF.
    • To confirm amrinone's potential as a therapeutic agent for CHF.

    Main Methods:

    • A comparative study involving 15 consecutive patients with CHF.
    • Hemodynamic parameters including cardiac index, pulmonary artery wedge pressure, heart rate, and mean arterial pressure were monitored.
    • Clinical tolerance and adverse reactions to each drug were assessed.

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    Main Results:

    • All three drugs improved maximal cardiac index similarly.
    • Dopamine did not decrease pulmonary artery wedge pressure and increased heart rate more than the others.
    • Dobutamine and amrinone demonstrated comparable hemodynamic benefits, significantly improving cardiac index and decreasing pulmonary artery wedge pressure.
    • Dobutamine and amrinone also produced similar modest decreases in mean arterial pressure and increments in heart rate.
    • Dopamine was poorly tolerated, leading to premature discontinuation in 5 patients due to severe adverse reactions.
    • Amrinone and dobutamine were better tolerated, with amrinone causing only asymptomatic tachycardia in 4 patients.

    Conclusions:

    • Dobutamine and amrinone provide similar hemodynamic support for CHF patients.
    • Amrinone is a well-tolerated alternative to dopamine and dobutamine in managing decompensating CHF.
    • Amrinone's favorable hemodynamic profile and better tolerability warrant its consideration in CHF treatment.