Comparative effects on hemodynamics of enoximone (MDL 17,043), dobutamine and nitroprusside in severe congestive heart failure

• Published in: The American journal of cardiology Vol. 60; no. 5; pp. 46 - 52
• Main Authors: Installé, Etienne, Gonzalez, Manuel, Jacquemart, Jean Luc, Collard, Philippe, Roulette, Francois, Pourbaix, Suzanne, Tremouroux, Jean
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 14-08-1987
• Subjects: Aged; Cardiotonic Agents - pharmacology; Cardiotonic Agents - therapeutic use; Clinical Trials as Topic; Dobutamine - pharmacology; Dobutamine - therapeutic use; Enoximone; Female; Ferricyanides - pharmacology; Heart Failure - drug therapy; Heart Failure - physiopathology; Hemodynamics - drug effects; Humans; Imidazoles - pharmacology; Imidazoles - therapeutic use; Male; Middle Aged; Nitroprusside - pharmacology; Nitroprusside - therapeutic use
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(87)90525-X

To assess their comparative effects on hemodynamics, nitroprusside, dobutamine and enoximone were sequentially administered to 10 patients with severe congestive heart failure. Nitroprusside, dobutamine (at 10 gmg/kg/min) and enoximone (at 2 mg/kg) increased stroke volume index to a similar extent (31%, 34% and 36%, respectively). Enoximone produced less tachycardia than dobutamine and, consequently, a smaller improvement in cardiac index. Mean arterial pressure was not altered by dobutamine but was reduced 9% by enoximone, 2 mg/kg. This finding accounts for the larger (although not significant) increase in left ventricular stroke work index observed with dobutamine compared with enoximone. Ventricular filling pressures and vascular resistances were significantly decreased by all 3 drugs (p = 0.001). All 3 drugs improved cardiac pump function when assessed by the increase in stroke index to a similar extent; however, enoximone (2 mg/kg) resulted in less hypotension than nitroprusside (mean arterial pressure −9% vs −22%, p = 0.0001) and in less tachycardia than dobutamine 10 μg/kg/min. Those differences in mode of action account for the variations observed in the heart rate-blood pressure product (dobutamine 10 μg/kg/min, +18%, enoximone 2 mg/kg, −5%, p = 0.003). Enoximone thus appears to be of great value in the management of severe congestive heart failure by its combination of vasodilatory and inotropic properties. Enoximone (2 mg/kg) provides a clinically significant increase in cardiac index, a clear reduction of ventricular filling pressures, a moderate reduction of mean arterial pressure and only minor changes of heart rate and of rate pressure product.