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Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure

A randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol

Marco Metra, MD^*,*, Savina Nodari, MD^*, Antonio D’Aloia, MD^*, Claudio Muneretto, MD, Alastair D. Robertson, PhD, Michael R. Bristow, MD, PhD and Livio Dei Cas, MD^*

^* Cattedra di Cardiologia, Università di Brescia, Brescia, Italy
Cattedra di Cardiochirurgia, Università di Brescia; Brescia, Italy
Department of Medicine, Division of Cardiology, University of Colorado Health Sciences Center, Denver, Colorado, USA

View larger version (32K): [in a new window]   Figure 1 Absolute changes (mean ± SEM) from baseline in cardiac index after dobutamine (left figures) or enoximone (right figures) administration, before (open symbols) and after (closed symbols) long-term beta-blocker treatment with metoprolol (upper figures) or carvedilol (lower figures). Asterisks immediately above or below the standard error bars indicate significance of dose-specific differences from baseline. Asterisks between the dose-response curves indicate significance of dose-specific differences in the changes from baseline between before and after beta-blocker therapy. Significance values at the bottom of each graph indicate differences between the slopes of the dose response curves before and after metoprolol or carvedilol treatment. *p < 0.05; **p < 0.01; ***p < 0.001.

View larger version (28K): [in a new window]   Figure 2 Absolute changes (mean ± SEM) from baseline in heart rate and stroke volume index after dobutamine or enoximone administration, before (open symbols) and after (closed symbols) long-term beta-blocker treatment with metoprolol (upper figures) or carvedilol (lower figures). Significance of symbols as in Figure 1.

View larger version (29K): [in a new window]   Figure 3 Absolute changes (mean ± SEM) from baseline in the pulmonary wedge pressure and right atrial pressure after dobutamine or enoximone administration before (open symbols) and after (closed symbols) long-term beta-blocker treatment with metoprolol (upper figures) or carvedilol (lower figures). Significance of symbols as in Figure 1.

View larger version (28K): [in a new window]   Figure 4 Absolute changes (mean ± SEM) from baseline in the mean arterial pressure and systemic vascular resistance after dobutamine or enoximone administration before (open symbols) and after (closed symbols) long-term beta-blocker treatment with metoprolol (upper figures) or carvedilol (lower figures). Significance of symbols as in Figure 1.

View larger version (29K): [in a new window]   Figure 5 Absolute changes (mean ± SEM) from baseline in the mean pulmonary artery pressure and pulmonary vascular resistance after dobutamine or enoximone administration before (open symbols) and after (closed symbols) long-term beta-blocker treatment with metoprolol (upper figures) or carvedilol (lower figures). Significance of symbols as in Figure 1.