A Dobutamine paradox: eosinophilic myocarditis in the explanted heart of a 9-year-old girl undergoing cardiac transplantation

Fenton, Matthew; Burch, Milbre; Sebire, Neil J.

doi:10.1017/s1047951105001411

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…[12] In terms of adverse effects, dobutamine and has been proven to be arrhythmogenic in most dosage schemes, it has also been linked to the rare occurrence of eosinophilic myocarditis. [13–15]…”

Section: Traditional Inotropesmentioning

confidence: 99%

Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice

et al. 2019

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Inotropes are pharmacological agents that are indicated for the treatment of patients presenting with acute heart failure (AHF) with concomitant hypoperfusion due to decreased cardiac output. They are usually administered for a short period during the initial management of AHF until haemodynamic stabilisation and restoration of peripheral perfusion occur. They can be used for longer periods to support patients as a bridge to a more definite treatment, such as transplant of left ventricular assist devices, or as part of a palliative care regimen. The currently available inotropic agents in clinical practice fall into three main categories: beta-agonists, phosphodiesterase III inhibitors and calcium sensitisers. However, due to the well-documented potential for adverse events and their association with increased long-term mortality, physicians should be aware of the indications and dosing strategies suitable for different types of patients. Novel inotropes that use alternative intracellular pathways are under investigation, in an effort to minimise the drawbacks that conventional inotropes exhibit.

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Section: Traditional Inotropesmentioning

confidence: 99%

Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice

et al. 2019

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“…However, there have been case reports linking the use of inotropes, in particular dobutamine, to eosinophilic myocardial hypersensitivity (EMH) reactions. [5][6][7][8] In observational studies of patients who have undergone transplantation, eosinophilic or hypersensitivity myocarditis has been reported in 7%-23% of explanted hearts. [9][10][11] Despite several case reports of dobutamine hypersensitivity, there remains a lack of data on incidence and predictors of EMH in patients receiving home inotrope therapy.…”

Section: Introductionmentioning

confidence: 99%

“…However, there have been case reports linking the use of inotropes, in particular dobutamine, to eosinophilic myocardial hypersensitivity (EMH) reactions. 5–8 In observational studies of patients who have undergone transplantation, eosinophilic or hypersensitivity myocarditis has been reported in 7%–23% of explanted hearts. 9–11…”

Section: Introductionmentioning

confidence: 99%

Incidence and Predictors of Eosinophilic Myocardial Hypersensitivity in Patients Receiving Home Dobutamine

Dagan

Lankaputhra

Yeung

et al. 2022

Journal of Cardiovascular Pharmacology

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We sought to examine incidence and predictors of eosinophilic myocardial hypersensitivity (EMH) in a cohort of patients in the home inotrope program of a quaternary cardiac transplant center. Patients on home inotropes with progression to heart transplantation or ventricular assist device (VAD) between January 2000 and May 2020 were included. EMH was diagnosed by the presence of an interstitial predominate eosinophilic infiltrate within the myocardium by experienced cardiac pathologists. From a cohort of 74 patients, 58% (43) were on dobutamine and 42% (31) were on milrinone. Dobutamine was associated with EMH incidence of 14% (6/43), with zero cases in the milrinone cohort. Mean age was 52 6 12 years, 22% were female. More than half (62%) were nonischemic dilated cardiomyopathies, the remainder were ischemic cardiomyopathy. Dobutamine dose [250 (200-282) vs. 225 (200-291) mg/min] and duration of therapy [41 (23-79) vs. 53 (24-91) days] was similar between those with and without EMH. Median change in eosinophil count was 0.31 • 10 9 /L in the EMH group compared with only 0.03 • 10 9 /L in the non-EMH cohort, P = 0.02. Increase in peripheral eosinophil count of .0.20 • 10 9 /L demonstrated good discrimination between those with and without EMH, c-statistic 0.83 (95% CI 0.66-1.0). Heart failure hospitalization occurred in 83% of the EMH group versus 59% in the non-EMH group, P = 0.26. Requirement for VAD was significantly higher in the EMH group (83% vs. 41%, P = 0.05). In conclusion, EMH occurred in 14% of patients receiving home dobutamine. Rising eosinophil count should prompt physicians to consider EMH and switch to milrinone to avoid possible escalation to VAD.

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Systemic Organ Manifestations of Drug Allergy

Lerch

Harr

2022

Cutaneous Drug Hypersensitivity

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A Dobutamine paradox: eosinophilic myocarditis in the explanted heart of a 9-year-old girl undergoing cardiac transplantation

Cited by 6 publications

References 6 publications

Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice

Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice

Incidence and Predictors of Eosinophilic Myocardial Hypersensitivity in Patients Receiving Home Dobutamine

Systemic Organ Manifestations of Drug Allergy

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