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A single German center experience with intermittent inotropes for patients on the high-urgent heart transplant waiting list

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Abstract

Aim

Currently, more than 900 patients with end-stage heart failure are listed for heart transplantation in Germany. All patients on the Eurotransplant high-urgent status (HU) have to be treated in intensive care units and have to be relisted every 8 weeks. Long-term continuous inotropes are associated with tachyphylaxia, arrhythmias and even increased mortality. In this retrospective analysis, we report our single center experience with HU patients treated with intermittent inotropes as a bridging therapy.

Methods and results

117 consecutive adult HU candidates were treated at our intensive care heart failure unit between 2008 and 2013, of whom 14 patients (12 %) were stabilized and delisted during follow-up. In the remaining 103 patients (age 42 ± 15 years), different inotropes (dobutamine, milrinone, adrenaline, noradrenaline, levosimendan) were administered based on the patient’s specific characteristics. After initial recompensation, patients were weaned from inotropes as soon as possible. Thereafter, intermittent inotropes (over 3–4 days) were given as a predefined weekly (until 2011) or 8 weekly regimen (from 2011 to 2013). In 57 % of these patients, additional regimen-independent inotropic support was necessary due to hemodynamic instabilities. Fourteen patients (14 %) needed a left- or biventricular assist device; 14 patients (14 %) died while waiting and 87 (84 %) received heart transplants after 87 ± 91 days. Cumulative 3 and 12 months survival of all 103 patients was 75 and 67 %, respectively.

Conclusion

Intermittent inotropes in HU patients are an adequate strategy as a bridge to transplant; the necessity for assist devices was low. These data provide the basis for a prospective multicenter trial of intermittent inotropes in patients on the HU waiting list.

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References

  1. Felker GM, O’Connor CM (2001) Inotropic therapy for heart failure: an evidence-based approach. Am Heart J 142:393–401

    Article  CAS  PubMed  Google Scholar 

  2. Mortara A, Oliva F, Metra M, Carbonieri E, Di Lenarda A, Gorini M, Midi P, Senni M, Urso R, Lucci D, Maggioni AP, Tavazzi L (2014) Treatment with inotropes and related prognosis in acute heart failure: contemporary data from the italian network on heart failure (in-hf) outcome registry. J Heart Lung Transplant 33:1056–1065

    Article  PubMed  Google Scholar 

  3. Gorodeski EZ, Chu EC, Reese JR, Shishehbor MH, Hsich E, Starling RC (2009) Prognosis on chronic dobutamine or milrinone infusions for stage d heart failure. Circ Heart Fail 2:320–324

    Article  CAS  PubMed  Google Scholar 

  4. Liang CS, Sherman LG, Doherty JU, Wellington K, Lee VW, Hood WB Jr (1984) Sustained improvement of cardiac function in patients with congestive heart failure after short-term infusion of dobutamine. Circulation 69:113–119

    Article  CAS  PubMed  Google Scholar 

  5. Hatzizacharias A, Makris T, Krespi P, Triposkiadis F, Voyatzi P, Dalianis N, Kyriakidis M (1999) Intermittent milrinone effect on long-term hemodynamic profile in patients with severe congestive heart failure. Am Heart J 138:241–246

    Article  CAS  PubMed  Google Scholar 

  6. Thackray S, Easthaugh J, Freemantle N, Cleland JG (2002) The effectiveness and relative effectiveness of intravenous inotropic drugs acting through the adrenergic pathway in patients with heart failure-a meta-regression analysis. Eur J Heart Fail 4:515–529

    Article  CAS  PubMed  Google Scholar 

  7. Bayram M, De Luca L, Massie MB, Gheorghiade M (2005) Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes. Am J Cardiol 96:47G–58G

    Article  CAS  PubMed  Google Scholar 

  8. Levin R, Porcile R, Tanus E, Degrange M (2009) The intermittent infusion of levosimendan reduces mortality and re-admisions in patients with advanced heart failure (abstract). Circulation 120:S865

    Article  Google Scholar 

  9. Bergh CH, Andersson B, Dahlstrom U, Forfang K, Kivikko M, Sarapohja T, Ullman B, Wikstrom G (2010) Intravenous levosimendan versus dobutamine in acute decompensated heart failure patients on beta-blockers. Eur J Heart Fail 12:404–410

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Bonios MJ, Terrovitis JV, Drakos SG, Katsaros F, Pantsios C, Nanas SN, Kanakakis J, Alexopoulos G, Toumanidis S, Anastasiou-Nana M, Nanas JN (2011) Comparison of three different regimens of intermittent inotrope infusions for end stage heart failure. Int J Cardiol 159:225–229

    Article  PubMed  Google Scholar 

  11. Nanas JN, Kontoyannis DA, Alexopoulos GP, Anastasiou-Nana MI, Tsagalou EP, Stamatelopoulos SF, Moulopoulos SD (2001) Long-term intermittent dobutamine infusion combined with oral amiodarone improves the survival of patients with severe congestive heart failure. Chest 119:1173–1178

    Article  CAS  PubMed  Google Scholar 

  12. Nanas JN, Tsagalou EP, Kanakakis J, Nanas SN, Terrovitis JV, Moon T, Anastasiou-Nana MI (2004) Long-term intermittent dobutamine infusion, combined with oral amiodarone for end-stage heart failure: a randomized double-blind study. Chest 125:1198–1204

    Article  CAS  PubMed  Google Scholar 

  13. Mavrogeni S, Giamouzis G, Papadopoulou E, Thomopoulou S, Dritsas A, Athanasopoulos G, Adreanides E, Vassiliadis I, Spargias K, Panagiotakos D, Cokkinos DV (2007) A 6-month follow-up of intermittent levosimendan administration effect on systolic function, specific activity questionnaire, and arrhythmia in advanced heart failure. J Card Fail 13:556–559

    Article  CAS  PubMed  Google Scholar 

  14. Lilleberg J, Laine M, Palkama T, Kivikko M, Pohjanjousi P, Kupari M (2007) Duration of the haemodynamic action of a 24-h infusion of levosimendan in patients with congestive heart failure. Eur J Heart Fail 9:75–82

    Article  CAS  PubMed  Google Scholar 

  15. Malfatto G, Della Rosa F, Villani A, Rella V, Branzi G, Facchini M, Parati G (2007) Intermittent levosimendan infusions in advanced heart failure: favourable effects on left ventricular function, neurohormonal balance, and one-year survival. J Cardiovasc Pharmacol 60:450–455

    Article  Google Scholar 

  16. Silvetti S, Greco T, Licia Di Prima A, Mucchetti M, Maria de Lurdes C, Pasin L, Scandroglio M, Landoni G, Zangrillo A (2014) Intermittent levosimendan improves mid-term survival in chronic heart failure patients: meta-analysis of randomised trials. Clin Res Cardiol 103:505–513

    Article  CAS  PubMed  Google Scholar 

  17. Tuomainen P, Magga J, Timonen P, Miettinen K, Kurttila M, Vanninen E, Laitinen T, Timonen K, Punnonen K, Parviainen I, Uusaro A, Vuolteenaho O, Kivikko M, Peuhkurinen K (2013) Intermittent levosimendan treatment in patients with severe congestive heart failure. Clin Res Cardiol 102:485–493

    Article  CAS  PubMed  Google Scholar 

  18. Zobel C, Dörpinghaus M, Reuter H, Erdmann E (2012) Mortality in a cardiac intensive care unit. Clin Res Cardiol 101:521–524

    Article  PubMed  Google Scholar 

  19. Adamopoulos S, Piepoli M, Qiang F, Pissimissis E, Davies M, Bernardi L, Forfar C, Sleight P, Coats A (1995) Effects of pulsed beta-stimulant therapy on beta-adrenoceptors and chronotropic responsiveness in chronic heart failure. Lancet 345:344–349

    Article  CAS  PubMed  Google Scholar 

  20. Leier CV, Binkley PF (1998) Parenteral inotropic support for advanced congestive heart failure. Prog Cardiovasc Dis 41:207–224

    Article  CAS  PubMed  Google Scholar 

  21. Unverferth DV, Magorien RD, Altschuld R, Kolibash AJ, Lewis RP, Leier CV (1983) The hemodynamic and metabolic advantages gained by a three-day infusion of dobutamine in patients with congestive cardiomyopathy. Am Heart J 106:29–34

    Article  CAS  PubMed  Google Scholar 

  22. Colombo PC, Banchs JE, Celaj S, Talreja A, Lachmann J, Malla S, DuBois NB, Ashton AW, Latif F, Jorde UP, Ware JA, LeJemtel TH (2005) Endothelial cell activation in patients with decompensated heart failure. Circulation 111:58–62

    Article  CAS  PubMed  Google Scholar 

  23. Binkley PF, Van Fossen DB, Nunziata E, Unverferth DV, Leier CV (1990) Influence of positive inotropic therapy on pulsatile hydraulic load and ventricular-vascular coupling in congestive heart failure. J Am Coll Cardiol 15:1127–1135

    Article  CAS  PubMed  Google Scholar 

  24. Unverferth DV, Leier CV, Magorien RD, Croskery R, Svirbely JR, Kolibash AJ, Dick MR, Meacham JA, Baba N (1980) Improvement of human myocardial mitochondria after dobutamine: a quantitative ultrastructural study. J Pharmacol Exp Ther 215:527–532

    CAS  PubMed  Google Scholar 

  25. Jessup M, Banner N, Brozena S, Campana C, Costard-Jackle A, Dengler T, Hunt S, Metra M, Rahmel A, Renlund D, Ross H, Warner Stevenson L (2006) Optimal pharmacologic and non-pharmacologic management of cardiac transplant candidates: approaches to be considered prior to transplant evaluation: International society for heart and lung transplantation guidelines for the care of cardiac transplant candidates–2006. J Heart Lung Transplant 25:1003–1023

    Article  PubMed  Google Scholar 

  26. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013) 2013 accf/aha guideline for the management of heart failure: a report of the american college of cardiology foundation/american heart association task force on practice guidelines. Circulation 128:e240–e327

    Article  PubMed  Google Scholar 

  27. Teerlink JR, Metra M, Zaca V, Sabbah HN, Cotter G, Gheorghiade M, Cas LD (2009) Agents with inotropic properties for the management of acute heart failure syndromes. Traditional agents and beyond. Heart Fail Rev 14:243–253

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. De Luca L (2014) Inotropic agents in advanced heart failure: repetita iuvant? Int J Cardiol 176:6–7

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medizinische Abteilung, Kliniken der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Renatastrasse 71a, 80639, Munich, Germany

    T. Hübner, T. Nickel, A. Kiwi & Michael Weis

  2. Zentrum für Kardiologie am Klinikum Starnberg, Starnberg, Germany

    G. Steinbeck

  3. Medizinische Klinik und Poliklinik I, Universitätsklinikum Großhadern der Ludwig-Maximilans Universität, Munich, Germany

    S. Massberg

  4. Herzchirurgische Klinik, Universitätsklinikum Großhadern der Ludwig-Maximilans Universität, Munich, Germany

    R. Schramm & C. Hagl

  5. Walter Brendel Center for Experimental Medicine, Munich, Germany

    B. Reichart

Authors
  1. T. Hübner
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  2. T. Nickel
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  3. G. Steinbeck
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  4. S. Massberg
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  8. A. Kiwi
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  9. Michael Weis
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Correspondence to Michael Weis.

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Hübner, T., Nickel, T., Steinbeck, G. et al. A single German center experience with intermittent inotropes for patients on the high-urgent heart transplant waiting list. Clin Res Cardiol 104, 929–934 (2015). https://doi.org/10.1007/s00392-015-0852-1

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  • DOI: https://doi.org/10.1007/s00392-015-0852-1

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