RECUPERO DELLA FUNZIONE DI POMPA IN SOGGETTO CON CARDIOPATIA IPOCINETICA ISCHEMICA TRATTATA CON DOBUTAMINA IN INFUSIONE INTERMITTENTE SETTIMANALE. UN CASO CLINICO

The case is reported of a 69-year-old man with refractory heart failure due to ischemic cardiomyopathy. All other available treatments having failed and 250 mg doses of furosemide having been administered without success, dobutamine infusion was tried, at first with 72 hours of continuous infusion of 5 mcg/kg/min, followed by intermittent infusion at the same dosage, first with 12-h intervals, subsequently at the rate of 2-3 infusions weekly, and finally, after about 50 days, with a single weekly infusion. Clinical and hemodynamic results were brillant with the patient passing from grade IV NYHA to grade II and from ejection fraction 21% (Teichholz M-mode measurement) to 55%, 14 months after the start of dobutamine treatment. Discussing the possible mechanisms of this favourable result, the authors stress the possible improvement of the contractility of the 'stunned' or 'hibernating' myocardial segments. On the basis of their experience and of data in the literature, the authors underline the validity of the therapeutic protocol of intermittent dobutamine infusion for severe heart failure.