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Clinical Investigations in Critical Care |

Long-term Intermittent Dobutamine Infusion Combined With Oral Amiodarone Improves the Survival of Patients With Severe Congestive Heart Failure*

John N. Nanas, MD; Dimitrios A. Kontoyannis, MD; George P. Alexopoulos, MD; Maria I. Anastasiou-Nana, MD; Eleftheria P. Tsagalou, MD; Stamatis F. Stamatelopoulos, MD; Spyridon D. Moulopoulos, MD
Author and Funding Information

*From the University of Athens School of Medicine, Department of Clinical Therapeutics, “Alexandra” Hospital, Athens, Greece.

Correspondence to: John N. Nanas, MD, Makedonias 24, GR: 104 33, Athens, Greece



Chest. 2001;119(4):1173-1178. doi:10.1378/chest.119.4.1173
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Study objective: To evaluate the effects of long-term intermittent dobutamine infusion (IDI) with concomitant administration of low-dose amiodarone in patients with congestive heart failure (CHF) refractory to standard medical treatment.

Design: Prospective, interventional clinical trial.

Setting: Inpatient and outpatient heart failure clinic in a university teaching hospital.

Patients and interventions: Twenty-two patients with CHF refractory to standard treatment who could be weaned from dobutamine therapy after an initial 72-h infusion were included in this study. The first 11 patients (group 1) were treated with IDI, 10μ g/kg/min, as needed (mean, once every 16 days, lasting for 12 to 48 h); the next 11 patients (group 2) received oral amiodarone, 400 mg/d, and IDI, 10 μg/kg/min, for 8 h every 7 days.

Measurement and results: There were no differences in baseline clinical, hemodynamic, and five biochemical characteristics between the two groups. The left ventricular ejection fraction was 13.5 ± 4.5% in group 1 vs 15.5 ± 4.9% in group 2 (mean ± SD; p = 0.451); mean pulmonary capillary wedge pressure was 31.3 ± 4.4 mm Hg vs 29.4 ± 3.3 mm Hg (p = 0.316); serum creatinine was 1.9 ± 0.4 mg/dL vs 1.6 ± 0.5 mg/dL (p = 0.19); and serum Na was 139.6 ± 6.2 mEq/L vs 138.4 ± 3.1 mEq/L (p = 0.569). At 12 months of follow-up, 1 of 11 patients (9%) was alive in group 1 vs 6 of 11 patients (55%) in group 2 (p = 0.011). Furthermore, in group 2, the functional status improved significantly within the first 3 months of treatment, from New York Heart Association functional class IV to 2.63 ± 0.5 (p = 0.0001).

Conclusion: Long-term IDI in conjunction with amiodarone, added to conventional drugs, improved clinical status and survival of patients with severe CHF.

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