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13. Inotropic effect of enoximone in patients with severe heart failure: Demonstration by left ventricular end-systolic pressure-volume analysis

Author

Herrmann, Howard C., Ruddy, Terrence D., William Dec, G., William Strauss, H., Boucher, Charles A., and Fifer, Michael A.

Abstract

Left ventricular end-systolic pressure-volume analysis was employed to assess the inotropic effect of the phosphodiesterase inhibitor enoximone (formerly MDL-17,043) in nine patients with severe heart failure (New York Heart Association class IV symptoms, mean ejection fraction = 0.22). Left ventricular pressure-volume loops were constructed using high fidelity left ventricular pressure measured with micromanometer-tipped catheters and simultaneous left ventricular volume obtained by gated blood pool imaging. Afterload was reduced with the vasodilator nitroprusside to generate the baseline left ventricular end-systolic pressure-volume relation, a relatively load-independent measure of contractile function.

Published
1987
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15. 969-92 Right Ventricular Ejection Fraction is Superior to MVO2in Predicting Event-free Survival in Advanced Heart Failure

Author

Di Salvo, Thomas, Mathier, Michael, McNamara, Dennis, Semigran, Marc, and William Dec, G.

Abstract

Functional capacity assessed by maximum oxygen consumption (MV02) and percent age-sex adjusted MVO2achieved (% MVO2) predicts survival in heart failure (HF). To determine the exercise parameters which best predict survival, 66 patients with advanced HF (mean age 51±9.9 mean ± SD; 58% NYHA III, 18% NYHA IV; mean LVEF 0.22±0.07) underwent simultaneous cardiopulmonary exercise testing and first-pass rest/exercise radionuc1ide ventriculography during transplant (TX) evaluation. Mean MV02was 11.8±4.2 ml/kg/min, mean % MVO238±11.9%. During median followup 93 weeks, 16/66 patients (25%) died. Univariate predictors of survival included restRVEF > 0.35, exRVEF > 0.35, and % MVO2> 45% (all p<0.05). In a multivariate proportional hazards survival model, exRVEF > 0.35 (p<0.01) and % MV02> 45% (p=0.01) were selected as predictors. 28/66 patients (42%) reached the combined end-point of death or hospitalization for inotropic/mechanical bridging (IN) to cardiac TX. Univariate predictors of IN-free survival included restRVEF > 0.35 (p=0.01), exRVEF > 0.35 (p<0.01). NYHAC (p<0.05), mid % MV02> 45% (p=0.05). exRVEF > 0.35 (p=0.01) was the only predictor of IN-free survival selected in a multivariate proportional hazards model. MV02, CI rest/exercise, LVEF rest/exercise, exercise-related rise or fall> 0.05 in LVEF or RVEF were not predictive of survival or IN-free survival in any univariate or multivariate analysis.

Published
1995
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