Enoximone versus epinephrine/nitroglycerin in cardiac low-output states following valve replacement

This prospective, randomized, comparative study was designed to assess the inotropic and vasodilatory effects of the selective phosphosidesterase III inhibitor enoximone compared with standard therapy with epinephrine/nitroglycerin in patients with refractory low output states following cardiac valve replacement. Enoximone possesses inotropic and vasodilatory properties and has proven to be of beneficial effect in patients suffering from severely impaired myocardial function. Six patients in each group received either enoximone bolus-infusion of 0.5 mg/kg over 10 min followed by an infusion of 5 micrograms/kg/min up to 20 micrograms/kg/min or epinephrine and nitroglycerin infusion of 0.05 and 0.5 micrograms/kg/min, respectively, for 4 hours postoperatively. Hemodynamic effects of enoximone and the combination of epinephrine/nitroglycerin were compared. Both treatments led to positive inotropy with a simultaneous decrease in filling pressures and vascular resistances. The results indicate that enoximone in low-output states following cardiac valve replacement was at least equally effective in comparison with standard therapy with epinephrine and nitroglycerin.