[Intermittent infusions of dobutamine in the treatment of chronic cardiac failure in the terminal stage]. / Perfusions intermittentes de dobutamine dans le traitement des défaillances cardiaques chroniques au stade terminal.

This study was designed to evaluate the efficacy of intermittent dobutamine infusions in patients with end-stage congestive heart failure. Twenty-four patients with NYHA Stage IV congestive heart failure were included. Mean age was 65.8 years (range 40-85). All patients were under optimal medical therapy with digitalis, diuretics and vasodilating agents. Diagnosis was coronary heart disease in 11 patients, dilated cardiomyopathy in 9, and valvular incompetence in 4. Dobutamine was given in an initial dosage of 2.5 micrograms/kg/min increased by 2.5 micrograms/kg/min every 15 minutes until the desired effect was achieved. Mean dosage was 10 micrograms/kg/min. Patients were given an identical infusion two weeks later, then at monthly intervals after improvement of the clinical status. Heart failure stage was improved in all patients: 14 patients were stage II and 10 were stage III. Ejection fraction failed to improve (19.5 +/- 10 to 18.5 +/- 5). Mortality rate was 5% at one year, 24% at two years, and 45% at four years.