Hemodynamic Goals Are Relevant

Stevenson, Lynne Warner

doi:10.1161/circulationaha.104.478321

Cited by 71 publications

(9 citation statements)

References 94 publications

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“…7,12,13 Enoximone is a non-glycoside, non-catecholamine, imidazolone derivative that selectively inhibits sarcoplasmic-reticulum-associated type IIIa and IIIb phosphodiesterase, leading to increased levels of intracellular cAMP. 14 Similar to other type III phosphodiesterase inhibitors (PDEIs), 15,16 long-term administration of enoximone at high doses (≥100 mg t.i.d.)…”

Section: Introductionmentioning

confidence: 99%

Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials

Metra

Eichhorn

Abraham

et al. 2009

European Heart Journal

120

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AimsUse of inotropic agents in patients with heart failure (HF) has been limited by adverse effects on outcomes. However, administration of positive inotropes at lower doses and concomitant treatment with beta-blockers might increase benefit–risk ratio. We investigated the effects of low doses of the positive inotrope enoximone on symptoms, exercise capacity, and major clinical outcomes in patients with advanced HF who were also treated with beta-blockers and other guideline-recommended background therapy.Methods and resultsThe Studies of Oral Enoximone Therapy in Advanced HF (ESSENTIAL) programme consisted of two identical, randomized, double-blind, placebo-controlled trials that differed only by geographic location (North and South America: ESSENTIAL-I; Europe: ESSENTIAL-II). Patients with New York Heart Association class III–IV HF symptoms, left ventricular ejection fraction ≤30%, and one hospitalization or two ambulatory visits for worsening HF in the previous year were eligible for participation in the trials. The trials had three co-primary endpoints: (i) the composite of time to all-cause mortality or cardiovascular hospitalization, analysed in the two ESSENTIAL trials combined; (ii) the 6 month change from baseline in the 6 min walk test distance (6MWTD); and (iii) the Patient Global Assessment (PGA) at 6 months, both analysed in each trial separately. ESSENTIAL-I and -II randomized 1854 subjects at 211 sites in 16 countries. In the combined trials, all-cause mortality and the composite, first co-primary endpoint did not differ between the two treatment groups [hazard ratio (HR) 0.97; 95% confidence interval (CI) 0.80–1.17; and HR 0.98; 95% CI 0.86–1.12, respectively, for enoximone vs. placebo]. The two other co-primary endpoints were analysed separately in the two ESSENTIAL trials, as prospectively designed in the protocol. The 6MWTD increased with enoximone, compared with placebo, in ESSENTIAL-I (P = 0.025, not reaching, however, the pre-specified criterion for statistical significance of P < 0.020), but not in ESSENTIAL-II. No difference in PGA was observed in either trial.ConclusionAlthough low-dose enoximone appears to be safe in patients with advanced HF, major clinical outcomes are not improved.

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Section: Introductionmentioning

confidence: 99%

Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials

Metra

Eichhorn

Abraham

et al. 2009

European Heart Journal

120

View full text Add to dashboard Cite

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“…Elevated left sided filling pressures result in subendocardial ischemia as a result of a decreased coronary perfusion gradient and mitral regurgitation as a result of annular dilatation, which in turn further lowers cardiac output. (9) If high enough, these filling pressures result in frank pulmonary edema but otherwise may manifest as exercise intolerance and fatigue. Moreover, elevated left sided filling pressures lead to high pulmonary pressures, the so called ‘group 2’ pulmonary hypertension.…”

Section: The Hemodynamics Of Hfmentioning

confidence: 99%

Long-term management of end-stage heart failure

Habal

Garan

2017

Best Practice & Research Clinical Anaesthesiology

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End-stage heart failure manifests as severe and often relentless symptoms that define the clinical syndrome of heart failure, namely congestion and hypoperfusion. These patients suffer from dyspnea, fatigue, abdominal discomfort and ultimately cardiac cachexia. Renal and hepatic dysfunction frequently further complicate the process. Recurrent hospitalizations, cardiac arrhythmias, and intolerance to standard heart failure therapies are common as the disease progresses. Management focuses on controlling symptoms, correcting precipitants, avoiding triggers, and maximizing therapies with demonstrable survival benefit. Amongst appropriate candidates, advanced therapies such as orthotopic heart transplant (OHT) can significantly extend survival and improve quality-of-life. Left ventricular assist devices (LVADs) have been used with increasing frequency as a bridge to OHT or as destination therapy in appropriately selected candidates where they have a demonstrable mortality benefit over medical therapy. Importantly, a multidisciplinary patient-centred approach is crucial when considering these advanced therapies.

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“…An approach to TM, which employs a 'health maintenance' strategy which is being investigated in the heartcycle program [6,7], has developed in the last decade [8,9]. Enabling patients to measure their hemodynamic status on a regular basis in their own home with the transmission of information to an expert system and clinician overview could transform the way care for HF is given.…”

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confidence: 99%

The utility of novel non-invasive technologies for remote hemodynamic monitoring in chronic heart failure

Mabote

Wong

Cleland

2014

Expert Review of Cardiovascular Therapy

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Monitoring a patient's hemodynamic status may be a revolutionary way to aid a 'health maintenance' strategy in which the physician strives to therapeutically keep the patient in an ideal hemodynamic range. Currently, home telemonitoring employs a 'crisis-prevention' approach. This strategy is still based on easily acquired measures such as heart rate, weight and blood pressure--measurements that are useful to help implement guideline-directed therapy but provide little information about impending decompensation or the risk of hospitalisation. Current systems provide limited information to personalize and adapt medication therapy for heart failure. Several innovative technologies that can remotely monitor estimates of cardiovascular hemodynamics, such as cardiac index, systemic vascular resistance, augmentation index and added heart sounds may enable earlier detection of heart failure decompensation. This editorial presents an overview of the innovative technologies that are available for non-invasive hemodynamic monitoring and maybe adapted for home telemonitoring for chronic heart failure.

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Hemodynamic Goals Are Relevant

Cited by 71 publications

References 94 publications

Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials

Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials

Long-term management of end-stage heart failure

The utility of novel non-invasive technologies for remote hemodynamic monitoring in chronic heart failure

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