Document Detail

Myocardial energetics and clinical response to the cardiotonic agent MDL 17043 in advanced heart failure.
MedLine Citation:
PMID:  6238075     Owner:  NLM     Status:  MEDLINE    
Cardiotonic agents may prove useful in the long-term treatment of chronic heart failure provided myocardial efficiency is enhanced and clinical status is improved. Accordingly, the short-term hemodynamic and clinical response to the phosphodiesterase inhibitor, MDL 17043, was evaluated. Intravenous increments of 0.05 mg/kg (maximal total 3 mg/kg) were given to a peak cardiac output response in 13 patients with New York Heart Association functional class IV heart failure secondary to ischemic or myopathic disease. Significant (p less than 0.05) responses at peak effect (1.7 mg/kg) included an increase in cardiac output (3.5 to 4.6 liters/min) and heart rate (86 to 90 beats/min) and a decrease in pulmonary capillary wedge (25 to 17 mm Hg), mean arterial (85 to 78 mm Hg) and right atrial (10 to 7 mm Hg) pressures. Coronary sinus flow (measured in nine patients) increased (122 to 144 ml/min, p less than 0.01) as did myocardial oxygen uptake (14.1 to 15.1 ml/min, p less than 0.01), whereas myocardial extraction of oxygen (78 to 72%, p less than 0.01) and lactate (24 to 9%, p less than 0.01) decreased with three patients producing lactate at the time of their peak cardiac output response. Nine of the 12 patients given long-term oral therapy improved at least one functional class at 2 weeks. This improvement was sustained at 20 weeks in five patients. Thus, MDL 17043 acutely improves the function of the failing heart. However, the decrease in oxygen extraction occurring with increased myocardial oxygen uptake suggests that intracoronary shunting may occur along with an increase in oxygen demand and contribute to myocardial anaerobiosis in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)
J L Martin; M J Likoff; J S Janicki; W K Laskey; J W Hirshfeld; K T Weber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  4     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1984 Nov 
Date Detail:
Created Date:  1984-11-28     Completed Date:  1984-11-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  875-83     Citation Subset:  IM    
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MeSH Terms
Cardiac Output / drug effects
Cardiotonic Agents / therapeutic use*
Coronary Circulation / drug effects
Heart Failure / drug therapy*,  metabolism,  physiopathology
Heart Rate / drug effects
Hemodynamics / drug effects*
Imidazoles / metabolism,  therapeutic use*
Lactates / metabolism
Middle Aged
Myocardium / metabolism*
Oxygen Consumption / drug effects
Pulmonary Wedge Pressure / drug effects
Reg. No./Substance:
0/Cardiotonic Agents; 0/Imidazoles; 0/Lactates; 77671-31-9/Enoximone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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