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Angiotensin II receptor type 1 blocker and angiotensin-converting enzyme inhibitor association to severe decompensated heart failure with dobutamine-dependence: effects in hemodynamic, clinical outcomes and mortality


The purpose of the present study is assess the effectiveness of addition of angiotensin II receptor type 1 blocker to optimized angiotensin converting-enzyme inhibitor use in acute decompensated chronic heart failure, with prolonged dobutamine dependence (refractory cardiogenic shock). This is a randomized, double-blind, placebo-controlled study. Hemodynamic variables (cardiac index, systemic vascular resistance and pulmonary wedge capilar pressure), BNP, occurrence of successful dobutamine withdrawal and mortality should be analyzed. Inclusion criteria: decompensated heart failure, left ventricular ejection fraction < 0.45, and dobutamine use > 15 days. Exclusion criteria: systolic blood pressure < 70mmHg, serum urea > 150 mg/dL, serum creatinine > 3.0 mg/dL, serum potassium > 6.0 mEq/L, aortic stenosis, acute coronary syndrome < 2 months. Patients will be randomized to losartan or placebo, by double-blind fashion. The primary endpoint are successful dobutamine withdrawal and total mortality, and the secondary endpoint are increase of cardiac index and reduction of pulmonary capillary wedge pressure. Sample size is 60 patients. Survival free-event curves will be built by Kaplan-Meier method and compared by Log-Rank test. Mortality will be analyzed by Cox regression. (AU)

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(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
OCHIAI, MARCELO E.; BRANCALHAO, EULER C. O.; PUIG, RAPHAEL S. N.; VIEIRA, KELLY R. N.; CARDOSO, JULIANO N.; DE OLIVEIRA-, JR., MUCIO TAVARES; BARRETTO, ANTONIO C. P.. Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial. Clinics, v. 69, n. 5, p. 308-313, . (06/06463-9)

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