Dec G W, Fifer M A, Herrmann H C, Cocca-Spofford D, Semigran M J
Cardiac Unit, Massachusetts General Hospital, Boston 02114.
Am Heart J. 1993 Feb;125(2 Pt 1):423-9. doi: 10.1016/0002-8703(93)90021-z.
Few options are available for patients with severe heart failure that is unresponsive to therapy with digoxin, diuretics, and vasodilators. The clinical responses and predictors of survival were studied in 41 consecutive patients with New York Heart Association (NYHA) class IV heart failure during long-term oral enoximone therapy (mean dose 232 +/- 15 mg/day). The mean age was 60 +/- 1 years, and the initial left ventricular ejection fraction was 0.19 +/- 0.01. The cause of heart failure was either coronary artery disease (n = 23) or dilated cardiomyopathy (n = 18). Symptomatic improvement occurred in the majority (83%) of patients; 24% improved two or more NYHA classes. Although the 12-month mortality rate for the entire group was high (54 +/- 8%), a subgroup of patients with dilated cardiomyopathy achieved a sustained benefit with a decrease in symptoms > 1 NYHA class, fewer hospitalizations, and a survival rate at 24 months of 60%. Multivariate analysis identified the cause of heart failure, left ventricular ejection fraction, and clinical improvement within 60 days of enoximone therapy as predictors of a favorable long-term outcome. The presence of coronary artery disease was most predictive of early mortality (p < 0.0002), with only 5% of patients surviving > 18 months compared to 66% of those with dilated cardiomyopathy. Median survival rates were 132 +/- 31 and 921 +/- 214 days (p < 0.001) for the coronary artery disease and dilated cardiomyopathy populations, respectively. Oral enoximone can provide symptomatic improvement and a palliative option for the majority of patients with refractory heart failure resulting from cardiomyopathy.
对于那些对洋地黄、利尿剂和血管扩张剂治疗无反应的重度心力衰竭患者，可供选择的治疗方案很少。我们对41例纽约心脏协会（NYHA）IV级心力衰竭患者进行了长期口服依诺昔酮治疗（平均剂量232±15mg/天），研究了其临床反应和生存预测因素。患者平均年龄为60±1岁，初始左心室射血分数为0.19±0.01。心力衰竭的病因是冠状动脉疾病（n = 23）或扩张型心肌病（n = 18）。大多数（83%）患者症状有所改善；24%的患者心功能改善两级或更多。尽管整个组的12个月死亡率很高（54±8%），但扩张型心肌病亚组患者症状持续改善，心功能改善>1级纽约心脏协会分级，住院次数减少，24个月生存率为60%。多因素分析确定心力衰竭病因、左心室射血分数以及依诺昔酮治疗60天内的临床改善情况为长期良好预后的预测因素。冠状动脉疾病的存在最能预测早期死亡率（p < 0.0002），冠状动脉疾病患者只有5%存活超过18个月，而扩张型心肌病患者为66%。冠状动脉疾病和扩张型心肌病患者的中位生存时间分别为132±31天和921±214天（p < 0.001）。口服依诺昔酮可为大多数因心肌病导致的难治性心力衰竭患者提供症状改善和姑息治疗选择。
