ISSN:
1432-1440
Keywords:
Congestive heart failure
;
PDE inhibition
;
Positive inotropic action
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary Enoximone, a phosphodiesterase-inhibitor, is a potent inotropic vasodilator agent that causes a marked improvement in hemodynamics in patients with congestive heart failure. The acute effects of oral enoximone on rest and exercise hemodynamics, ejection fraction, aerobic metabolism, exercise capacity, and arrhythmias were studied in 11 patients with moderate to moderately severe dilative cardiomyopathy after 8 days of enoximone (100 mg tid) in addition to baseline therapy (diuretics and digitalis). The cardiac index increased from 2.44±0.45 to 2.72±0.50 l/min/m2 (p〈0.01) at rest and from 4.00±0.96 to 4.75±0.95 l/min/m2 (p〈0.005) during exercise. Pulmonary wedge pressure decreased from 16.8±7.3 to 12.5±6.5 mmHg (p〈0.005) at rest and from 28.2±8.0 to 24.5±10.3 mmHg (p〈 0.05) during exercise. Systemic vascular resistance decreased from 1608±243 to 1495±300 dynes*sec*cm−5 (p〈0.05) at rest and from 1152±155 to 1027±236 dynes*sec*cm−5 (ns) during exercise. The anaerobic threshold, which was recorded simultaneously, increased from 13.2±2.7 to 15.5± 2.5ml/kg/min VO2 (p〈0.02). The radionuclide ventriculography ejection fraction improved from 21.7±5.0 to 28.1±9.1% (p〈0.01) during exercise; the changes at rest were not significant (20.8±6.2 vs 25.8±8.4%). Exercise tolerance showed an increase of 16% (492±133 to 573±135 sec, p〈 0.005). The resting heart rate remained unchanged (81.8±13.4 vs 81.8±11.9). Interestingly, 24-h Holter monitoring revealed more or new repetitive arrhythmias in 9/11 patients. Short-term therapy with oral enoximone enhances ventricular performance by increasing cardiac contractility and lowering vascular resistance, both of which extend exercise tolerance and improve aerobic metabolism. Potential proarrhythmic effects need further evaluation, however.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01666828
Permalink
