Search tips
Search criteria 


Logo of heartHeartVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Heart. 1996 September; 76(3): 223–231.
PMCID: PMC484511

Effect of pimobendan on exercise capacity in patients with heart failure: main results from the Pimobendan in Congestive Heart Failure (PICO) trial.


PRIMARY OBJECTIVE: To determine the effects of pimobendan 2.5 and 5 mg daily on exercise capacity in patients with chronic heart failure. DESIGN: A randomised, double blind, placebo controlled trial of the addition of pimobendan to conventional treatment with a minimum follow up of 24 weeks. SETTING: Outpatient cardiology clinics in six European countries. PATIENTS: 317 patients with stable symptomatic heart failure, objectively impaired exercise capacity, and an ejection fraction of 45% or lower who were treated with at least an angiotensin converting enzyme inhibitor and a diuretic and who tolerated a test dose of pimobendan. RESULTS: Compared with placebo, both pimobendan 2.5 and 5 mg daily improved exercise duration (bicycle ergometry) by 6% (P = 0.03 and 0.05) after 24 weeks of treatment. At that time 63% of patients allocated to pimobendan and 59% of those allocated to placebo were alive and able to exercise to at least the same level as at entry (P = 0.5). No significant effects on oxygen consumption (assessed in a subgroup of patients) and on quality of life (assessed by questionnaire) were observed. Pimobendan was well tolerated. Proarrhythmic effects (24-hour electrocardiography) were not observed. In both pimobendan groups combined the hazard of death was 1.8 (95% confidence interval 0.9 to 3.5) times higher than in the placebo group. CONCLUSIONS: Pimobendan improves exercise capacity in patients with chronic heart failure who are also on conventional treatment. The balance between benefit and risk of treatment with this compound remains to be established however.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kulka PJ, Tryba M. Inotropic support of the critically ill patient. A review of the agents. Drugs. 1993 May;45(5):654–667. [PubMed]
  • Colucci WS, Wright RF, Braunwald E. New positive inotropic agents in the treatment of congestive heart failure. Mechanisms of action and recent clinical developments. 2. N Engl J Med. 1986 Feb 6;314(6):349–358. [PubMed]
  • Uretsky BF, Jessup M, Konstam MA, Dec GW, Leier CV, Benotti J, Murali S, Herrmann HC, Sandberg JA. Multicenter trial of oral enoximone in patients with moderate to moderately severe congestive heart failure. Lack of benefit compared with placebo. Enoximone Multicenter Trial Group. Circulation. 1990 Sep;82(3):774–780. [PubMed]
  • Packer M, Carver JR, Rodeheffer RJ, Ivanhoe RJ, DiBianco R, Zeldis SM, Hendrix GH, Bommer WJ, Elkayam U, Kukin ML, et al. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. N Engl J Med. 1991 Nov 21;325(21):1468–1475. [PubMed]
  • Hagemeijer F. Calcium sensitization with pimobendan: pharmacology, haemodynamic improvement, and sudden death in patients with chronic congestive heart failure. Eur Heart J. 1993 Apr;14(4):551–566. [PubMed]
  • Hasenfuss G, Holubarsch C, Heiss HW, Just H. Influence of UDCG-115 on hemodynamics and myocardial energetics in patients with idiopathic dilated cardiomyopathy. Am Heart J. 1989 Sep;118(3):512–519. [PubMed]
  • Katz SD, Kubo SH, Jessup M, Brozena S, Troha JM, Wahl J, Cohn JN, Sonnenblick EH, LeJemtel TH. A multicenter, randomized, double-blind, placebo-controlled trial of pimobendan, a new cardiotonic and vasodilator agent, in patients with severe congestive heart failure. Am Heart J. 1992 Jan;123(1):95–103. [PubMed]
  • Kubo SH, Gollub S, Bourge R, Rahko P, Cobb F, Jessup M, Brozena S, Brodsky M, Kirlin P, Shanes J, et al. Beneficial effects of pimobendan on exercise tolerance and quality of life in patients with heart failure. Results of a multicenter trial. The Pimobendan Multicenter Research Group. Circulation. 1992 Mar;85(3):942–949. [PubMed]
  • Sasayama S, Asanoi H, Kihara Y, Yokawa S, Terada Y, Yoshida S, Ejiri M, Horikoshi I. Clinical effects of long-term administration of pimobendan in patients with moderate congestive heart failure. Heart Vessels. 1994;9(3):113–120. [PubMed]
  • Remme WJ, Krayenbühl HP, Baumann G, Frick MH, Haehl M, Nehmiz G, Baiker W. Long-term efficacy and safety of pimobendan in moderate heart failure. A double-blind parallel 6-month comparison with enalapril. The Pimobendan-Enalapril Study Group. Eur Heart J. 1994 Jul;15(7):947–956. [PubMed]
  • Morganroth J, Borland M, Chao G. Application of a frequency definition of ventricular proarrhythmia. Am J Cardiol. 1987 Jan 1;59(1):97–99. [PubMed]
  • PEARSON ES, HARTLEY HO. Charts of the power function for analysis of variance tests, derived from the non-central F-distribution. Biometrika. 1951 Jun;38(1-2):112–130. [PubMed]
  • Narang R, Swedberg K, Cleland JG. What is the ideal study design for evaluation of treatment for heart failure? Insights from trials assessing the effect of ACE inhibitors on exercise capacity. Eur Heart J. 1996 Jan;17(1):120–134. [PubMed]
  • Lubsen J. Exercise testing as outcome in congestive heart failure trials. Design considerations when interpreting results. Drugs. 1994;47 (Suppl 4):25–30. [PubMed]
  • Feldman AM. Classification of positive inotropic agents. J Am Coll Cardiol. 1993 Oct;22(4):1223–1227. [PubMed]

Articles from Heart are provided here courtesy of BMJ Group