Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1983 Sep;50(3):282–289. doi: 10.1136/hrt.50.3.282

Symptoms, haemodynamics, and exercise capacity during long term treatment of chronic heart failure. Experience with pirbuterol.

J R Dawson, R Canepa-Anson, P Kuan, S R Reuben, P A Poole-Wilson, G C Sutton
PMCID: PMC481410  PMID: 6137226

Abstract

An open study of long term treatment with an oral beta 2 agonist (pirbuterol 20 mg three times daily) was undertaken in 63 patients with severe chronic heart failure. During three months of treatment 20 (32%) patients died, of whom 16 were taking the drug at the time of death. Mortality was related to initial functional class (New York Heart Association classification: 23% in grade III and 75% in grade IV). Concomitant treatment with digoxin did not affect mortality. The drug was well tolerated by most patients but unwanted side effects necessitated withdrawal of the drug in six (10%). Thirty-five patients were continuing to take the drug after three months, of whom 22 reported symptomatic improvement and only four deterioration. There was a relation between symptomatic improvement and increase in exercise capacity. At initial haemodynamic assessment a single dose of pirbuterol increased the cardiac index by 34% and the stroke index by 21%. Left ventricular filling pressure fell by 23% and systemic vascular resistance by 22%. Haemodynamic reassessment after three months of continuous treatment in 29 patients showed maintained improvement in the group as a whole, although individual variation was considerable. There was no apparent relation between haemodynamic improvement and improvement in exercise duration and symptoms. Severe heart failure has a poor prognosis. Identification of those patients who may derive benefit from treatment with a particular drug is not yet possible.

Full text

PDF
282

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ader R., Chatterjee K., Ports T., Brundage B., Hiramatsu B., Parmley W. Immediate and sustained hemodynamic and clinical improvement in chronic heart failure by an oral angiotensin-converting enzyme inhibitor. Circulation. 1980 May;61(5):931–937. doi: 10.1161/01.cir.61.5.931. [DOI] [PubMed] [Google Scholar]
  2. Awan N. A., Needham K., Evenson M. K., Hermanovich J., Joye J. A., DeMaria A. N., Mason D. T. Therapeutic efficacy or oral pirbuterol in severe chronic congestive heart failure: acute hemodynamic and long-term ambulatory evaluation. Am Heart J. 1981 Sep;102(3 Pt 2):555–563. doi: 10.1016/0002-8703(81)90744-4. [DOI] [PubMed] [Google Scholar]
  3. Bruce R. A. Exercise testing of patients with coronary heart disease. Principles and normal standards for evaluation. Ann Clin Res. 1971 Dec;3(6):323–332. [PubMed] [Google Scholar]
  4. Canepa-Anson R., Dawson J. R., Frankl W. S., Kuan P., Sutton G. C., Reuben S., Poole-Wilson P. A. Beta 2 adrenoceptor agonists. Pharmacology, metabolic effects and arrhythmias. Eur Heart J. 1982 Dec;3 (Suppl 500):129–134. [PubMed] [Google Scholar]
  5. Chatterjee K., Ports T. A., Brundage B. H., Massie B., Holly A. N., Parmley W. W. Oral hydralazine in chronic heart failure: sustained beneficial hemodynamic effects. Ann Intern Med. 1980 May;92(5):600–604. doi: 10.7326/0003-4819-92-5-600. [DOI] [PubMed] [Google Scholar]
  6. Colucci W. S., Alexander R. W., Williams G. H., Rude R. E., Holman B. L., Konstam M. A., Wynne J., Mudge G. H., Jr, Braunwald E. Decreased lymphocyte beta-adrenergic-receptor density in patients with heart failure and tolerance to the beta-adrenergic agonist pirbuterol. N Engl J Med. 1981 Jul 23;305(4):185–190. doi: 10.1056/NEJM198107233050402. [DOI] [PubMed] [Google Scholar]
  7. Davis R., Ribner H. S., Keung E., Sonnenblick E. H., LeJemtel T. H. Treatment of chronic congestive heart failure with captopril, an oral inhibitor of angiotensin-converting enzyme. N Engl J Med. 1979 Jul 19;301(3):117–121. doi: 10.1056/NEJM197907193010301. [DOI] [PubMed] [Google Scholar]
  8. Dawson J. R., Canepa-Anson R., Kuan P., Whitaker N. H., Carnie J., Warnes C., Reuben S. R., Poole-Wilson P. A., Sutton G. C. Treatment of chronic heart failure with pirbuterol: acute haemodynamic responses. Br Med J (Clin Res Ed) 1981 May 2;282(6274):1423–1426. doi: 10.1136/bmj.282.6274.1423. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Elkayam U., Lejemtel T. H., Mathur M., Ribner H. S., Frishman W. H., Strom J., Sonnenblick E. H. Marked early attenuation of hemodynamic effects of oral prazosin therapy in chronic congestive heart failure. Am J Cardiol. 1979 Sep;44(3):540–545. doi: 10.1016/0002-9149(79)90409-0. [DOI] [PubMed] [Google Scholar]
  10. Falkner F. C., McIlhenny H. M. Selected ion monitoring assay for the bronchodilator pirbuterol. Biomed Mass Spectrom. 1976 Oct;3(5):207–211. doi: 10.1002/bms.1200030503. [DOI] [PubMed] [Google Scholar]
  11. Firth B. G., Dehmer G. J., Markham R. V., Jr, Willerson J. T., Hillis L. D. Assessment of vasodilator therapy in patients with severe congestive heart failure: limitations of measurements of left ventricular ejection fraction and volumes. Am J Cardiol. 1982 Nov;50(5):954–959. doi: 10.1016/0002-9149(82)90401-5. [DOI] [PubMed] [Google Scholar]
  12. Fitchett D. H., Neto J. A., Oakley C. M., Goodwin J. F. Hydralazine in the management of left ventricular failure. Am J Cardiol. 1979 Aug;44(2):303–309. doi: 10.1016/0002-9149(79)90321-7. [DOI] [PubMed] [Google Scholar]
  13. Franciosa J. A. Effectiveness of long-term vasodilator administration in the treatment of chronic left ventricular failure. Prog Cardiovasc Dis. 1982 Jan-Feb;24(4):319–330. doi: 10.1016/0033-0620(82)90009-3. [DOI] [PubMed] [Google Scholar]
  14. Guiha N. H., Cohn J. N., Mikulic E., Franciosa J. A., Limas C. J. Treatment of refractory heart failure with infusion of nitroprusside. N Engl J Med. 1974 Sep 19;291(12):587–592. doi: 10.1056/NEJM197409192911201. [DOI] [PubMed] [Google Scholar]
  15. Miller R. R., Awan N. A., Maxwell K. S., Mason D. T. Sustained reduction of cardiac impedance and preload in congestive heart failure with the antihypertensive vasodilator prazosin. N Engl J Med. 1977 Aug 11;297(6):303–307. doi: 10.1056/NEJM197708112970604. [DOI] [PubMed] [Google Scholar]
  16. Morand P., Lavigne G. Tolérance et accidents du traitement de l'insuffisance cardiaque sévère par la dihydralazine. Therapie. 1980 Sep-Oct;35(5):645–648. [PubMed] [Google Scholar]
  17. Packer M., Le Jemtel T. H. Physiologic and pharmacologic determinants of vasodilator response: a conceptual framework for rational drug therapy for chronic heart failure. Prog Cardiovasc Dis. 1982 Jan-Feb;24(4):275–292. doi: 10.1016/0033-0620(82)90006-8. [DOI] [PubMed] [Google Scholar]
  18. Packer M., Meller J., Gorlin R., Herman M. V. Hemodynamic and clinical tachyphylaxis to prazosin-mediated afterload reduction in severe chronic congestive heart failure. Circulation. 1979 Mar;59(3):531–539. doi: 10.1161/01.cir.59.3.531. [DOI] [PubMed] [Google Scholar]
  19. Packer M., Meller J., Medina N., Yushak M., Gorlin R. Hemodynamic characterization of tolerance to long-term hydralazine therapy in severe chronic heart failure. N Engl J Med. 1982 Jan 14;306(2):57–62. doi: 10.1056/NEJM198201143060201. [DOI] [PubMed] [Google Scholar]
  20. Patterson J. A., Naughton J., Pietras R. J., Gunnar R. M. Treadmill exercise in assessment of the functional capacity of patients with cardiac disease. Am J Cardiol. 1972 Nov;30(7):757–762. doi: 10.1016/0002-9149(72)90151-8. [DOI] [PubMed] [Google Scholar]
  21. Rouleau J. L., Warnica J. W., Burgess J. H. Prazosin and congestive heart failure: short- and long-term therapy. Am J Med. 1981 Jul;71(1):147–152. doi: 10.1016/0002-9343(81)90282-5. [DOI] [PubMed] [Google Scholar]
  22. Rude R. E., Turi Z., Brown E. J., Lorell B. H., Colucci W. S., Mudge G. H., Jr, Taylor C. R., Grossman W. Acute effects of oral pirbuterol on myocardial oxygen metabolism and systemic hemodynamics in chronic congestive heart failure. Circulation. 1981 Jul;64(1):139–145. doi: 10.1161/01.cir.64.1.139. [DOI] [PubMed] [Google Scholar]
  23. Sharpe D. N., Douglas J. E., Coxon R. J., Long B. Low-dose captopril in chronic heart failure: acute haemodynamic effects and long-term treatment. Lancet. 1980 Nov 29;2(8205):1154–1157. doi: 10.1016/s0140-6736(80)92593-3. [DOI] [PubMed] [Google Scholar]
  24. Taylor C. R., Baird J. R., Blackburn K. J., Cambridge D., Constantine J. W., Ghaly M. S., Hayden M. L., McIlhenny H. M., Moore P. F., Olukotun A. Y. Comparative pharmacology and clinical efficacy of newer agents in treatment of heart failure. Am Heart J. 1981 Sep;102(3 Pt 2):515–532. doi: 10.1016/0002-8703(81)90740-7. [DOI] [PubMed] [Google Scholar]
  25. Thadani U., Manyari D., Parker J. O., Fung H. L. Tolerance to the circulatory effects of oral isosorbide dinitrate. Rate of development and cross-tolerance to glyceryl trinitrate. Circulation. 1980 Mar;61(3):526–535. doi: 10.1161/01.cir.61.3.526. [DOI] [PubMed] [Google Scholar]
  26. Williams D. O., Bommer W. J., Miller R. R., Amsterdam E. A., Mason D. T. Hemodynamic assessment of oral peripheral vasodilator therapy in chronic congestive heart failure: prolonged effectiveness of isosorbide dinitrate. Am J Cardiol. 1977 Jan;39(1):84–90. doi: 10.1016/s0002-9149(77)80016-7. [DOI] [PubMed] [Google Scholar]
  27. Zelis R., Flaim S. F., Moskowitz R. M., Nellis S. H. How much can we expect from vasodilator therapy in congestive heart failure? Circulation. 1979 Jun;59(6):1092–1097. doi: 10.1161/01.cir.59.6.1092. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES