2013


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2013/№4

Vasodilators and inotropic drugs in decompensated chronic heart failure

Shchekochikhin D. Yu., Kopylov F. Yu., Syrkin A. L.
State Budgetary Educational Institution of Higher Professional Education, "I. M. Sechenov First Moscow State Medical University" of the RF Ministry of Health Care, Trubetskaya 8, Bldg. 2, Moscow 119991

Keywords: vasodilators, circulatory decompensation, inotropic drugs, treatment, CHF

DOI: 10.18087/rhfj.2013.4.1812

Managing patients with severe, decompensated CHF is a complicated issue. Limited number of large-scale studies and variability of clinical variants hamper making a decision in each specific case. Whether to use vasodilators and inotropic drugs in CHF is often determined based on the trial and error method and on experience of a given clinic. It is obvious that the strategy of early administration of vasoactive drugs in response to the first emerging signs of hypoperfusion and to the failure of low-dose diuretics is more likely to be beneficial. At the same time, using pressor doses of inotropic drugs as a desperate measure after using loop diuretics in doses increased to ototoxic ones and to development of pronounced electrolyte disorders leads to a fatal outcome in most cases.
  1. Мареев В. Ю., Даниелян М. О., Беленков Ю. Н. От имени рабочей группы исследования ЭПОХА–О–ХСН. Сравнительная характеристика больных с ХСН в зависимости от величины ФВ по результатам Российского многоцентрового исследования ЭПОХА–О–ХСН. Журнал Сердечная Недостаточность. 2006;7 (4):164–171.
  2. Vinson JM, Rich MW, Sperry JC et al. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc. 1990;38 (12):1290–1295.
  3. Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA. 2002;287 (5):628–640.
  4. Grady KL, Dracup K, Kennedy G et al. Team management of patients with heart failure: a statement for healthcare professionals from the Cardiovascular Nursing Council of the American Heart Association. Circulation. 2000;102 (19):2443–2456.
  5. Nohria A, Tsang SW, Fang JC et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003;41 (10):1797–1804.
  6. Argulian E, McPherson C, Kukin M. Organ-specific responses to circulatory disturbances in heart failure: new insights. Congest Heart Fail. 2012;18 (2):127–131.
  7. Ronco C, Haapio M, House AA et al. Cardiorenal syndrome. J. Am Coll Cardiol. 2008;52 (19):1527–1539.
  8. Stevenson LW, Massie BM, Francis GS. Optimizing therapy for complex or refractory heart failure: a management algorithm. Am Heart J. 1998;135 (6 Pt 2 Su): S293–309.
  9. Goldberg LI. Dopamine: clinical uses of an endogenous catecho­lamine. N Engl J Med. 1974;291 (14):707–710.
  10. Bart BA, Goldsmith SR, Lee KL et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367 (24):2296–2304.
  11. Monrad ES, Baim DS, Smith HS, Lanoue AS. Milrinone, dobutamine, and nitroprusside: comparative effects on hemodynamics and myocardial energetics in patients with severe congestive heart failure. Circulation. 1986;73 (3 Pt 2):III168–174.
  12. Drazner MH, Hamilton MA, Fonarow G, et al. Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure. J Heart Lung Transplant. 1999;18 (11):1126–1132.
  13. Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF). Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287 (12):1531–1540.
  14. Stevenson LW, Bellil D, Grover-McKay M et al. Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secon­dary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1987;60 (8):654–658.
  15. Rosario LB, Stevenson LW, Solomon SD et al. The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size. J Am Coll Cardiol. 1998;32 (7):1819–1824.
  16. Stevenson LW, Brunken RC, Belil D et al. Afterload reduction with vasodilators and diuretics decreases mitral regurgitation du­ring upright exercise in advanced heart failure. J Am Coll Cardiol. 1990;15 (1):174–180.
  17. Capomolla S, Pozzoli M, Opasich C et al. Dobutamine and nitroprusside infusion in patients with severe congestive heart failure: hemodynamic improvement by discordant effects on mitral regurgitation, left atrial function, and ventricular function. Am Heart J. 1997;134 (6):1089–1098.
  18. Silver MA, Horton DP, Ghali JK et al. Effect of nesiritide versus dobutamine on short-term outcomes in the treatment of patients with acutely decompensated heart failure. J Am Coll Cardiol. 2002;39 (5):798–803.
  19. Pflugfelder PW, O’Neill BJ, Ogilvie RI et al. A Canadian multicentre study of a 48 h infusion of milrinone in patients with severe heart failure. Can J Cardiol. 1991;7 (1):5–10.
  20. Abraham WT, Adams KF, Fonarow GC et al. In-hospital morta­lity in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005;46 (1):57–64.
  21. Elkayam U, Tasissa G, Binanay C et al. Use and impact of inotropes and vasodilator therapy in hospitalized patients with severe heart failure. Am Heart J. 2007;153 (1):98–104.
  22. Follath F, Cleland JG, Just H et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet. 2002;360 (9328):196–202.
  23. Stevenson LW. Clinical Use of Inotropic Therapy for Heart Failure: Looking Backward or Forward? Part I: Inotropic Infusions During Hospitalization. Circulation. 2003;108 (3):367–372.
  24. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33 (14):1787–1847.
  25. Mullens W, Abrahams Z, Francis GS et al. Sodium nitroprusside for advanced low-output heart failure. J Am Coll Cardiol. 2008;52 (3):200–207.
  26. Mullens W, Abrahams Z, Francis GS et al. Usefulness of Isosorbide Dinitrate and Hydralazine as add-on therapy in patients discharged for advanced decompensated heart failure. Am J Cardiol. 2009;103 (8):1113–1119.
  27. Robin ED, McCauley R. Nitroprusside-related cyanide poiso­ning: time (long past due. for urgent, effective interventions. Chest. 1992;102 (6):1842–1845.
  28. Schwartzenberg S, Redfield MM, From AM et al. Effects of vasodilation in heart failure with preserved or reduced ejection fraction implications of distinct pathophysiologies on response to therapy. J Am Coll Cardiol. 2012;59 (5):442–451.
  29. The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336 (8):525–533.
  30. Goldhaber JI, Hamilton MA. Role of inotropic agents in the treatment of heart failure. Circulation. 2010;121 (14):1655–1660.
  31. Friedrich JO, Adhikari N, Herridge MS, Beyene J. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med. 2005;142 (7):510–524.
  32. Leier CV, Heban PT, Huss P et al. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation. 1978;58 (3 Pt 1):466–475.
  33. Gorodeski EZ, Chu EC, Reese JR et al. Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure. Circ Heart Fail. 2009;2 (4):320–324.
  34. Felker GM, Benza RL, Chandler AB et al. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol. 2003;41 (6):997–1003.
  35. Mebazaa A, Nieminen MS, Packer M et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA. 2007;297 (17):1883–1891.
  36. Shakar SF, Abraham WT, Gilbert EM et al. Combined oral positive inotropic and beta-blocker therapy for treatment of refractory class IV heart failure. J Am Coll Cardiol. 1998;31 (6):1336–1340.
  37. Hauptman PJ, Mikolajczak P, George A et al. Chronic inotropic therapy in end-stage heart failure. Am Heart J. 2006;152 (6):1096.e1–8.
  38. López-Candales AL, Carron C, Schwartz J. Need for hospice and palliative care services in patients with end-stage heart failure trea­ted with intermittent infusion of inotropes. Clin Cardiol. 2004;27 (1):23–28.
Shchekochikhin D. Yu., Kopylov F. Yu., Syrkin A. L. Vasodilators and inotropic drugs in decompensated chronic heart failure. Russian Heart Failure Journal. 2013;14 (4):234-239

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