Beneficial hemodynamic effects of ibopamine are related to duration of congestive heart failure

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Abstract

Ibopamine (I) a di-isobutyric ester of N-methylodopamine, is an orally active dopamine agonist with favorable hemodynamic and neurohumoral properties. However, it has bad inconsistent efficacy in patients (PTS) with CHF. Since I has unique properties for treatment of CHF, characterization of responsive PTS would be advantageous. Sixteen PTS (15 males and 1 female, mean age 62 yr.) with mild to severe CHF (3 functional class II, 11 class III and 2 class IV), mean LV ejection fraction 22% (12-30%) and mean duration of CHF 33 mos (2-113) were studied after a single oral dose (200 mg) of I. Blood pressure (BP), heart rate, right heart pressures and cardiac index were obtained at baseline, 0.5, 2, 4, and 6 hr. after I. Analysis of the total group (TG) and two subgroups (short duration [SD] CHF [<7 mos]; long duration [LD] CHF [>18 mos]) were compared. There were no significant differences between the groups in demographics, etiology of CHF, functional class, ejection fraction or hemodynamics. Peak effect at 2 hr.: TG (n=16) SD (n=7) LD (n=9) Ctl 2-Hr Ctl 2-Hr Ctl 2-Hr Heart rate (bpm) 84.3 85.9 85.4 87.3 83.4 84.8 BP (mean) (mmHg) 92.8 94.9 88.1 86.0 96.3 92.4 PA wedge (mean) (mmHg) 21.9 18.1* 23.3 16.1* 20.8 19.6 Cardiac Index (1/min/m2) 2.10 2.64* 1.99 2.95* 2.19 2.40 Stroke Index (ml/min/m2) 24.9 30.7* 23.3 33.8* 26.2 28.3 Systemic Vas. Res. (d·s·cm·-5) 1782 1395* 1915 1299* 1678 1470** Stroke Work Index (g·m/m2) 25.6 32.1* 22.1 34.3* 28.3 30.3 *=p<.01 **=p<.05 I improved 5 hemodynamic variables in TG but only systemic vas. res. (SVR) was significantly altered in the LD group. However, in the SD group I significantly reduced pulomnary art. wedge pressure (PAW) and SVR and significantly increased cardiac index, stroke index and stroke work index. Thus the positive hemodynamic effects of I may be related to duration of CHF and this marker may be useful in PT selection for I therapy.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Volume44
Issue number1
StatePublished - 1996

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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