Circulation, Vol 65, 1382-1387, Copyright © 1982 by American Heart Association
CV Leier, P Huss, RP Lewis and DV Unverferth
Continuous 72-hour infusions of dobutamine reportedly effect sustained
clinical improvement in patients with congestive heart failure. This study
was designed to determine if shorter, more frequent infusions, delivered in
an outpatient setting, elicit a similar response. Twenty- six patients with
moderately severe congestive heart failure were randomized, 11 into a
control group and 15 into a dobutamine treatment group. Baseline data were
collected for 4 weeks in each group. Thereafter, the dobutamine treatment
group received 4-hour infusions of dobutamine weekly for 24 weeks. Systolic
time intervals, echocardiography, cardiac index and treadmill exercise
tolerance were used to follow the progress of the control and dobutamine
treatment groups. The ratio of preejection period to left ventricular
ejection time and the cardiac index did not change significantly in either
group. The velocity of circumferential fiber shortening and the percent
change in the minor axis of the left ventricle during systole improved
modestly (p less than 0.05) above baseline in the dobutamine group after 14
weeks of treatment and above the corresponding control values (p less than
0.05) after 22 weeks. Exercise tolerance (duration) improved 25--51% (all p
less than 0.05) above baseline in the dobutamine group compared with
10--17% (all p greater than 0.05 vs baseline) in the control group. Heart
rate at maximal exercise did not change significantly from baseline for
either group and did not differ significantly between the two groups.
Functional classification improved in 12 of 15 dobutamine treatment
patients and in only two of 11 control patients (p less than 0.05). In our
patients with congestive heart failure, weekly 4-hour dobutamine infusions
did not elicit a major change in resting left ventricular function;
however, exercise performance and clinical status improved considerably.
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