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3090 DOBUTAMINE-INDUCED HYPERSENSITIVITY MYOCARDITIS IN ENDSTAGE HEART FAILURE PATIENTS CY Lui1, Jared R.Younger2, Richard E. Sobonya,3 Francisco A. Arabia3 , Jack G. Copeland 1 U. Texas Medical Branch, Galveston, TX, USA, 2Southwestern U. Dallas, TX, USA, 3 U. of Arizona, Tucson, AZ, USA Hypersensitivity myocarditis has been associated with intravenous dobutamine therapy. However, the prognosis of such hypersensitivity myocarditis patients in end-stage heart failure patients awaiting heart transplant is not known. METHODS: Histological examination of 532 consecutively explanted hearts following orthotopic transplantation revealed hypersensitivity myocarditis in 28 patients. All 28 cases had been receiving dobutamine for decompensated heart failure prior to transplant. Each case was retrospectively matched with a dobutamine-treated patient from the same transplant cohort who did not develop hypersensitivity myocarditis. RESULTS: No medication was common among the group except dobutamine sodium bisulfite. The mean cumulative dose of dobutamine received in the cases was 410 ± 68 mg/kg versus 236 ± 38 mg/kg in the controls (p=0.032). Eosinophilia was seen in 63% of cases versus 22% of controls (p=0.002). Neither the cumulative dose nor the duration of dobutamine administered was significantly different between the two eosinophilia subgroups. Regarding clinical outcome, 39% of cases required ventricular assist device or total artificial heart versus 14% of controls (p=0.030). Nine of the 11 device patients had mild hypersensitivity myocarditis and all except one were successfully bridged to transplant.CONCLUSIONS: Prolonged infusion of dobutamine for treatment of decompensated heart failure is associated with hypersensitivity myocarditis and peripheral eosinophilia. This myocarditis was associated with worsening heart failure as evidenced by an increased need for mechanical ventricular assist device as bridge to transplant. These hypersensitivity myocarditis patients did not have a worse clinical outcome after heart transplantation.
