Hemodynamic effects of a new inotropic agent, piroximone (MDL 19205), in patients with chronic heart failure

Marc Petein, T. Barry Levine, Jay N. Cohn

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

The hemodynamic and neurohumoral effects of cummulative intravenous doses of piroximone (MDL 19205), a noncatecholamine, nonglycoside, imidazole derivative with positive inotropic and vasodilating properties, were studied in eight patients with severe congestive heart failure. A dose of 1.25 mg/kg in seven patients and 1.75 mg/kg in one patient increased cardiac index by 75% from 1.96 to 3.41 liters/min per m2 and decreased systemic vascular resistance (−41%), right atrial (−66%) and pulmonary wedge pressure (−35%) (all p < 0.005). Mean arterial pressure was slightly reduced from 78 to 71 mm Hg (p < 0.05) and forearm blood flow increased by 42%. Plasma norepinephrine decreased from 830 to 542 pg/ml (p < 0.05) and plasma renin activity tended to increase. In four patients, dobutamine (15 μg/kg per min) produced a comparable increase in cardiac index (+100%), but less decrease in pulmonary wedge pressure (−21 versus −41%, p < 0.05 versus piroximone) and, unlike piroximone, significantly increased heart rate (+22%, p < 0.05 versus piroximone) and heart rate-blood pressure product (+30%, p < 0.01 versus piroximone). In four other patients, a single intravenous dose of piroximone (1 mg/kg) resulted in a 35% increase in the first derivative of left ventricular pressure (dP/dt) from 796 to 1,068 mm Hg/s (p < 0.01). Thus, piroximone is a potent inotropic agent with an acute hemodynamic profile that may be more favorable than that of dobutamine. Because the drug is orally absorbed, clinical trials of chronic efficacy are indicated.

Original languageEnglish (US)
Pages (from-to)364-371
Number of pages8
JournalJournal of the American College of Cardiology
Volume4
Issue number2
DOIs
StatePublished - 1984

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