Keeping pre-transplant patients alive while waiting for a suitable donor is still a major challenge. New pharmacological agents which can provide improved hemodynamics are urgently needed in patients with severe heart failure who are on the waiting list for cardiac transplantation. Intravenous enoximone therapy (an initial 0.5 mg/kg bolus, then 1.25-5.0 mcg/kg/min infusion) was administered to 35 transplant candidates with progressive heart failure despite optimal drug regimen including digoxin, diuretics, and ACE-inhibitors. In 18 out of 35 patients complete hemodynamic, echocardiographic, neurohumoral, and Holter-ECG studies were performed before and 24 hours after intravenous enoximone infusion. Patients were then continued on chronic oral therapy of 100 mg twice a day. Enoximone infusion increased the cardiac index (CI) (1.78 +/- 0.45 l/min/m2 vs 3.04 +/- 0.83 l/min/m2; p< 0.001) and stroke volume index (SVI)(22.33 +/- 9.45 ml/m2 vs 32.28 +/- 7.29 ml/m2; p< 0.05) and decreased wedge pressure (PCP)(24.1 +/- 11.98 mmHg vs 17.78 +/- 8.76 mmHg; p< 0.05) while mean arterial pressure (MAP) was unchanged. Left ventricular ejection time (LVET)(225.1 +/- 26.9 ms vs 242.2 +/- 25.8 ms; p< 0.05) was increased whereas other echocardiographic parameters were unchanged (Left ventricular end-diastolic dimension LVEDD, left ventricular end-systolic dimension LVESD, fractional shortening FS, early diastolic relaxation parameter Te). Plasma neurohumoral parameters did not change (Aldosterone, epinephrine, renin, atrial natriuretic factor) except for a significant drop in norepinephrine (936.7 +/- 443.2 pg/ml vs 522.4 +/- 287.6 pg/ml; p< 0.05). Holter-ECG parameters (ventricular premature beats VPB, couplets, ventricular tachycardia VT) were not influenced by enoximone infusion.
Adult ; Electrocardiography, Ambulatory ; Enoximone/*therapeutic use ; Female ; Heart Failure, Congestive/physiopathology/therapy ; *Heart Transplantation ; Hemodynamics/drug effects ; Human ; Male ; Middle Age ; Preoperative Care

BACKGROUND: This clinical trial was performed to evaluate the hemodynamic and side effects of enoximone, a newly developed phosphodiesterase inhibitor, in moderately severe congestive heart failure in Korean population and to base the development of long acting oral preparations in the future. METHODS: Principal admission criteria for this trial were a left ventricular ejection fraction of less than 45% by radionuclide ventriculography, NYHA functional class II or III and a documented congestive cardiomyopathy. Exclusion criteria were restrictive cardiomyopathy, valvular heart disease, multisystemic lillness and uncontrolled ventricular tachyarrhythmia. The hemodynamic measurements were made by using the thermodilution Swan-Ganz catheter and radial arterial canulation. Enoximone was administered(continuous infusion) for 24 hours after initial bolus. The hemodynamic parameters to be observed were blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance. The clinical reponse, hematology, blood chemistry, and Holter monitoring were checked before and after enoximone trial. RESULTS: The following results are obtained. 1) The included patients were 15 females, 24 males, total 39 patients and mean age of 55.3 years old(28-70 years old). 2) The causes of congestive cardiomyopathy were idiopathic 35(89.9%), hypertensive 3(7.7%), and alcoholic 1(2.6%). 3) The mean ejection fraction measured by radionuclide left ventriculography were 28. 6%. 4) THe cardiac output was significantly increased(50%), and pulmonary capillary wedge pressure(38%), systemic vascular resistance(34%), pulmonary vascular resistance(27%) were significantly decreased during enoximone infusion. 5) NYHA Functional Class was improved by 1 step with enoximone. 6) There were no significant changes in hematology, blood chemistry, and Holter monitoring with enoximone. CONCLUSION: From the above results, the short term intravenous enoximone was very effective in moderately severe congestive heart failure in congestive cardiomyopathy without major adverse effects in Korean.
Alcoholics ; Blood Pressure ; Capillaries ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Catheters ; Chemistry ; Electrocardiography, Ambulatory ; Enoximone* ; Estrogens, Conjugated (USP)* ; Female ; Heart Failure* ; Heart Rate ; Heart Valve Diseases ; Hematology ; Hemodynamics* ; Humans ; Male ; Pulmonary Wedge Pressure ; Radionuclide Ventriculography ; Stroke Volume ; Tachycardia ; Thermodilution ; Vascular Resistance