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Hemodynamic effects of intravenous prenalterol in severe heart failure
Insights
Intravenous prenalterol improved heart function in patients with severe low output heart failure, increasing ejection fraction and cardiac index. However, it may also increase ventricular ectopic activity.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic severe low output heart failure presents significant hemodynamic challenges.
- Patients often exhibit reduced left ventricular ejection fraction and elevated filling pressures.
Purpose of the Study:
- To evaluate the hemodynamic effects of intravenous prenalterol in patients with chronic severe low output heart failure.
- To assess the safety and efficacy of prenalterol as an inotropic agent.
Main Methods:
- Nine patients with chronic severe low output heart failure received intravenous prenalterol at doses of 1, 4, and 8 mg.
- Hemodynamic parameters including left ventricular ejection fraction, filling pressure, cardiac index, and stroke work index were measured.
- Heart rate and mean systemic arterial pressure were also monitored.
Main Results:
- Prenalterol significantly improved hemodynamic function, increasing left ventricular ejection fraction from 17% to 26% and cardiac index from 1.9 to 2.4 L/min/m2.
- Left ventricular filling pressure decreased from 26 to 21 mm Hg, and left ventricular stroke work index increased from 18 to 25 g-m/m2.
- Adverse effects included increased ventricular ectopic beats and asymptomatic ventricular tachycardia in some patients.
Conclusions:
- Intravenous prenalterol demonstrates potential for hemodynamic improvement in patients with chronic severe low output heart failure.
- The use of prenalterol may be associated with an increased risk of ventricular ectopic activity.
Abstract:
Nine patients with chronic severe low output heart failure (radionuclide left ventricular ejection fraction 17 +/- 5 percent [mean +/- standard deviation], left ventricular filling pressure 26 +/- 6 mm Hg, cardiac index 1.9 +/- 0.4 liters/min per m2, left ventricular stroke work index 18 +/- 6 g-m/m2) from various causes were treated with intravenous prenalterol (a new catecholamine-like inotropic agent) in doses of 1,4 and 8 mg. Significant hemodynamic improvement occurred as measured by increased left ventricular ejection fraction (to 26 +/- 4 percent), decreased left ventricular filling pressure (to 21 +/- 8 mm Hg) and increased cardiac index (to 2.4 +/- 0.6 liters/min per m2) and left ventricular stroke work index (to 25 +/- 8 g-m/m2). Significant increases in heart rate (from 87 +/- 18 to 91 +/- 18 beats/min) and mean systemic arterial pressure (from 87 +/- 8 to 92 +/- 7 mm Hg) also occurred. Peak hemodynamic response occurred at various doses. Significant adverse effects associated with prenalterol consisted of increased ventricular ectopic beats in two patients and asymptomatic ventricular tachycardia in two patients. Thus, intravenous prenalterol produces hemodynamic improvement in patients with a chronic severe low output state but may be associated with increased ventricular ectopic activity.