Comparison of the effects of dopamine, hydralazine, and isosorbide dinitrate on myocardial hemodynamics in patients with refractory heart failure.

Nine patients with refractory congestive heart failure underwent hemodynamic study first with dopamine and then with oral hydralazine and sublingual isosorbide dinitrate. Although hemodynamic improvement was achieved with both forms of therapy, the beneficial effects of hydralazine alone or with isosorbide were superior to those of dopamine, as manifested by a greater reduction of wedge pressure and greater increase in stroke index. Six patients who demonstrated an increased wedge pressure during dopamine infusion were observed to manifest a louder apical systolic murmur and/or V wave in the wedge pressure tracing suggestive of enhanced mitral regurgitation. The rise in wedge pressure on dopamine could also be a consequence of increased myocardial ischemia and resultant decrease in ventricular compliance. It is possible that a subgroup of patients with heart failure are made worse by dopamine, and in these cases vasodilator therapy may be more beneficial.