Reverse left ventricular remodeling by intermittent dobutamine infusions and amiodarone in end-stage heart failure due to idiopathic dilated cardiomyopathy

BackgroundThe aim of this study was to evaluate the long-term effect of combined intermittent dobutamine infusions (IDI) and oral amiodarone on reverse left ventricular (LV) remodeling and hemodynamics of patients with idiopathic dilated cardiomyopathy (IDC) and end-stage congestive heart failure (CHF).MethodsThis non-randomized, prospective, clinical trial included sixteen consecutive patients suffering from dyspnea for a mean of 76 ± 43 months, who presented with acute cardiac decompensation and were weaned from dobutamine therapy after an initial 72-h infusion. They were then placed on a regimen of oral amiodarone, 400 mg/day and weekly IDI, 10 μg/kg/min, for 8 h. The long-term clinical outcomes and the effects of treatment on reverse LV remodeling (echocardiographic parameters) and hemodynamics were evaluated at 3, 6, and 12 months of follow up.ResultsA significant degree of reverse LV remodeling, hemodynamic improvements, and survivals > 1.5 years were observed in 9 of the 16 patients (56%). In addition, 5 patients (31% of entire cohort) were weaned from IDI after a mean of 61 ± 41 weeks, and 4 remained clinically stable for 116 ± 66 weeks thereafter. At 12 months of follow-up, LV end-diastolic and end-systolic volume indices had decreased from 231 ± 91 to 206 ± 80 ml/m2 (P = 0.002) and from 137 ± 65 to 110 ± 50 ml/m2 (P = 0.003), respectively, right atrial pressure from 16 ± 6 to 5.6 ± 4 mm Hg, (P = 0.031), and pulmonary capillary wedge pressure from 29 ± 4 to 16 ± 5.4 mm Hg, P = 0.000, while LV ejection fraction had increased from 22 ± 6% to 27.3 ± 8% (P = 0.006).ConclusionsIn end-stage CHF due to IDC, long-term treatment with IDI and oral amiodarone caused reverse LV remodeling, and allowed permanent and successful weaning from IDI in 1 / 4 of patients.