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Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol.
J Am Coll Cardiol. 2002 Oct 02; 40(7):1248-58.JACC

Abstract

OBJECTIVE

We compared the hemodynamic effects of dobutamine and enoximone administration before and after long-term beta-blocker therapy with metoprolol or carvedilol in patients with chronic heart failure (HF).

BACKGROUND

Patients with HF on beta-blocker therapy may need hemodynamic support with inotropic agents, and the hemodynamic response may be influenced by both the inotropic agent and the beta-blocker used.

METHODS

The hemodynamic effects of dobutamine (5 to 20 microg/kg/min intravenously) and enoximone (0.5 to 2 mg/kg intravenously) were assessed by pulmonary artery catheterization in 29 patients with chronic HF before and after 9 to 12 months of treatment with metoprolol or carvedilol at standard target maintenance oral doses. Hemodynamic studies were performed after >/=12 h of wash-out from all cardiovascular medications, except the beta-blockers that were administered 3 h before the second study.

RESULTS

Compared with before beta-blocker therapy, metoprolol treatment decreased the magnitude of mean pulmonary artery pressure (PAP) and pulmonary wedge pressure (PWP) decline during dobutamine infusion and increased the cardiac index (CI) and stroke volume index (SVI) response to enoximone administration, without any effect on other hemodynamic parameters. Carvedilol treatment abolished the increase in heart rate, SVI, and CI and caused a rise, rather than a decline, in PAP, PWP, systemic vascular resistance, and pulmonary vascular resistance during dobutamine infusion. The hemodynamic response to enoximone, however, was maintained or enhanced in the presence of carvedilol.

CONCLUSIONS

In contrast with its effects on enoximone, carvedilol and, to a lesser extent, metoprolol treatment may significantly inhibit the favorable hemodynamic response to dobutamine. No such beta-blocker-related attenuation of hemodynamic effects occurs with enoximone.

Authors+Show Affiliations

Cattedra di Cardiologia, Università di Brescia, Brescia, Italy. metramarco@libero.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12383572

Citation

Metra, Marco, et al. "Beta-blocker Therapy Influences the Hemodynamic Response to Inotropic Agents in Patients With Heart Failure: a Randomized Comparison of Dobutamine and Enoximone Before and After Chronic Treatment With Metoprolol or Carvedilol." Journal of the American College of Cardiology, vol. 40, no. 7, 2002, pp. 1248-58.
Metra M, Nodari S, D'Aloia A, et al. Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. J Am Coll Cardiol. 2002;40(7):1248-58.
Metra, M., Nodari, S., D'Aloia, A., Muneretto, C., Robertson, A. D., Bristow, M. R., & Dei Cas, L. (2002). Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. Journal of the American College of Cardiology, 40(7), 1248-58.
Metra M, et al. Beta-blocker Therapy Influences the Hemodynamic Response to Inotropic Agents in Patients With Heart Failure: a Randomized Comparison of Dobutamine and Enoximone Before and After Chronic Treatment With Metoprolol or Carvedilol. J Am Coll Cardiol. 2002 Oct 2;40(7):1248-58. PubMed PMID: 12383572.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. AU - Metra,Marco, AU - Nodari,Savina, AU - D'Aloia,Antonio, AU - Muneretto,Claudio, AU - Robertson,Alastair D, AU - Bristow,Michael R, AU - Dei Cas,Livio, PY - 2002/10/18/pubmed PY - 2002/11/26/medline PY - 2002/10/18/entrez SP - 1248 EP - 58 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 40 IS - 7 N2 - OBJECTIVE: We compared the hemodynamic effects of dobutamine and enoximone administration before and after long-term beta-blocker therapy with metoprolol or carvedilol in patients with chronic heart failure (HF). BACKGROUND: Patients with HF on beta-blocker therapy may need hemodynamic support with inotropic agents, and the hemodynamic response may be influenced by both the inotropic agent and the beta-blocker used. METHODS: The hemodynamic effects of dobutamine (5 to 20 microg/kg/min intravenously) and enoximone (0.5 to 2 mg/kg intravenously) were assessed by pulmonary artery catheterization in 29 patients with chronic HF before and after 9 to 12 months of treatment with metoprolol or carvedilol at standard target maintenance oral doses. Hemodynamic studies were performed after >/=12 h of wash-out from all cardiovascular medications, except the beta-blockers that were administered 3 h before the second study. RESULTS: Compared with before beta-blocker therapy, metoprolol treatment decreased the magnitude of mean pulmonary artery pressure (PAP) and pulmonary wedge pressure (PWP) decline during dobutamine infusion and increased the cardiac index (CI) and stroke volume index (SVI) response to enoximone administration, without any effect on other hemodynamic parameters. Carvedilol treatment abolished the increase in heart rate, SVI, and CI and caused a rise, rather than a decline, in PAP, PWP, systemic vascular resistance, and pulmonary vascular resistance during dobutamine infusion. The hemodynamic response to enoximone, however, was maintained or enhanced in the presence of carvedilol. CONCLUSIONS: In contrast with its effects on enoximone, carvedilol and, to a lesser extent, metoprolol treatment may significantly inhibit the favorable hemodynamic response to dobutamine. No such beta-blocker-related attenuation of hemodynamic effects occurs with enoximone. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/12383572/Beta_blocker_therapy_influences_the_hemodynamic_response_to_inotropic_agents_in_patients_with_heart_failure:_a_randomized_comparison_of_dobutamine_and_enoximone_before_and_after_chronic_treatment_with_metoprolol_or_carvedilol_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735109702021344 DB - PRIME DP - Unbound Medicine ER -