OBJECTIVES: We sought to assess the effects of combined oral positive inotropic and beta-blocker therapy in @entity1 with severe @entity712 . BACKGROUND: @entity1 with severe, class IV @entity712 who receive standard medical therapy exhibit a 1-year mortality rate >50%. Moreover, such @entity1 generally do not tolerate beta-blockade, a promising new therapy for @entity712 . Positive inotropes, including phosphodiesterase inhibitors, are associated with increased mortality when administered over the long term in these @entity1 . The addition of a beta-blocker to positive inotropic therapy might attenuate this adverse effect, although long-term oral inotropic therapy might serve as a bridge to beta-blockade. METHODS: Thirty @entity1 with severe @entity712 (left ventricular ejection fraction [LVEF] 17.2+/-1.2%, cardiac index 1.6+/-0.1 liter/min per m2) were treated with the combination of oral @entity17873 (a phosphodiesterase inhibitor) and oral @entity1406 at two institutions. @entity17873 was given at a dose of < or = 1 mg/kg body weight three times a day. After clinical stabilization, @entity1406 was initiated at 6.25 mg twice a day and slowly titrated up to a target dose of 100 to 200 mg/day. RESULTS: Ninety-six percent of the @entity1 tolerated enoximone, whereas 80% tolerated the addition of @entity1406 . The mean duration of combination therapy was 9.4+/-1.8 months. The mean length of follow-up was 20.9+/-3.9 months. Of the 23 @entity1 receiving the combination therapy, 48% were weaned off enoximone over the long term. The LVEF increased significantly, from 17.7+/-1.6% to 27.6+/-3.4% (p=0.01), whereas the New York Heart Association functional class improved from 4+/-0 to 2.8+/-0.1 (p=0.0001). The number of hospital admissions tended to decrease during therapy (p=0.06). The estimated probability of survival at 1 year was 81+/-9%. Heart transplantation was performed successfully in nine @entity1 (30%). CONCLUSIONS: Combination therapy with a positive inotrope and a beta-blocker appears to be useful in the treatment of severe, class IV @entity712 . It may be used as a palliative measure when transplantation is not an option or as a bridge to heart transplantation. Further study of this form of combined therapy is warranted.

Combined oral positive inotropic and beta-blocker therapy for treatment of refractory class IV XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity1406 :: ('MESH:D008790', 'Chemical') :: ['metoprolol'] @entity712 :: ('MESH:D006333', 'Disease') :: ['chronic heart failure', 'heart failure'] @entity17873 :: ('MESH:D017335', 'Chemical') :: ['enoximone', 'Enoximone']
@entity712 :: (MESH:D006333,Disease) :: ['heart failure']
