1031-35 Value of Ibopamine as Adjunct to Maximal Oral Medication in Patients with Moderately Severe Congestive Heart Failure; a Double-Blind, Placebo-controlled Study

Multiple drug therapy, including ACE inhibitors, diuretics, vasodilators and digoxin is currently used to reduce signs and symptoms of chronic heart failure (CHF). Optimal treatment of these patients (pts) is a major clinical problem, as the prevalence of CHF increases. Ibopamine, a novel oral dopamine agonist with peripheral vasodilating and neurohumoral inhibiting effects, may have additive value in the treatment of pts with moderately severe CHF, already treated with ACE-inhibitors.To evaluate the additive value of ibopamine as adjunctive to maximal CHF treatment we studied 60 pts with NYHA class III-IV CHF, who were assigned to treatment with ibopamine (3 dd 100mg) or placebo in a double-blind, randomized fashion.We examined the effect of ibopamine on peak oxygen consumption (VO2), neurohumoral factors and cardiac arrhythmias during 48 hrs ECG monitoring. Neurohumoral parameters were determined at rest and during exercise and included serum norepinephrine, epinephrine, aldosterone and plasma renin activity. All assessments were made at baseline and after 12 weeks of study treatment.Baseline dataOf the 60 pts, 40 pts (67%) had ischemic heart disease andlor old myocardial infarction, and 20 (33%) non-ischemic heart disease (16 pts (27%) dilated myocardiopathy). Mean age was 63±10 years, left ventricular ejection fraction 0.23±0.08, peak VO2 15.0±2.4 ml/min/kg and 44 of the patients (73%) were male. Background CHF therapy included ACE-inhibitors (100%), diuretics (100%), and digoxin, nitrates, amiodarone when required. At baseline resting serum norepinephrine was 724±78pg/ml, epinephrine 68±17pg/ml, aldosterone 0.50±0.08nmol/l and plasma renin activity 5.7±0.9ng/ml/hr.ResultsThe study was recently completed, the study data are currently analyzed and the results will be presented at the meeting

Serial angioscopic and angiographic observations during the first hour after successful coronary angioplasty: A preamble to a multicenter trial addressing angioscopic markers for restenosis

Percutaneous coronary angioscopy was used in 13 patients in a pilot study to assess the intracoronary changes that occur during the first hour after balloon angioplasty (PTCA). The dilated segment was studied with 4.5F angioscopes and with quantitative coronary angiography (QCA) immediately after PTCA and at 15-minute intervals for up to 1 hour after PTCA. Significant progression of intimal dissection and thrombus formation could be demonstrated with angioscopy. These dissections and thrombi remained undetected with angiography, which only showed haziness. Thus th

Continuously improving the practice of cardiology

Guidelines for the management of patients with cardiovascular disease are designed to assist cardiologists and other physicans in their practice. Surveys are conducted to assess whether guidelines are followed in practice. The results of surveys on acute coronary syndromes, coronary revascularisation, secondary prevention, valvular heart disease and heart failure are presented. Comparing surveys conducted between 1995 and 2002, a gradual improvement in use ofsecondary preventive therapy is observed. Nevertheless, important deviations from established guidelines are noted, with a significant variation among different hospitals in the Netherlands and in other European countries. Measures for fiuther improvement of clinical practice indude more rapid treatment of patients with evolving myocardial infarction, more frequent use of clopidogrel and glycoprotein IIb/IIIa receptor blockers in patients with acute coronary syndromes, more frequent use of 5-blockers in patients with heart failure and more intense measures to encourage patients to stop smoking. Targets for the proportion ofpatients who might receive specific therapies are presented

Chronic atrial fibrillation : success rate of serial cardioversion therapy and long-term safety of oral anticoagulation

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