What is the role of inotropic agents in the treatment of dilated cardiomyopathy?

Updated: Nov 28, 2018
  • Author: Vinh Q Nguyen, MD; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

Long-term use of the phosphodiesterase inhibitor milrinone has deleterious effects on survival in patients with heart failure. Improvement of chronic heart failure (CHF) symptoms occurs as the trade-off for this increase in mortality. Inotropic agents are reserved for patients who need hemodynamic-directed treatment during acute decompensation, for those who are refractory to maximal standard therapy, as palliation for end-stage heart failure, or as a bridge to transplantation for appropriate candidates.

Inotrope trials include the following:

  • Prospective Randomized Milrinone Survival Evaluation (PROMISE) (milrinone vs placebo) New York Heart Association (NYHA) class III-IV: increased mortality and morbidity rates with long-term therapy [118]

  • Xamoterol in Severe Heart Failure Study (xamoterol vs placebo), NYHA class III-IV: terminated because of excess mortality in xamoterol group [119]

  • Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) (milrinone or dobutamine vs placebo): routine administration of inotrope to hospitalized patients with decompensation who normally would not require it showed no impact on length of hospitalization and increased adverse events with milrinone

  • Vesnarinone Trial (VEST) (vesnarinone vs placebo), NYHA class III-IV: increased mortality rates


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