Acute effects of intravenous phosphodiesterase inhibition in chronic heart failure: simultaneous pre- and afterload reduction with a single agent.
Intravenous phosphodiesterase inhibition with milrinone is known to have a beneficial effect on haemodynamics in chronic heart failure. Its effect on lower limb capacitance vessels has not been previously investigated. We have studied the effect of intravenous milrinone in 10 patients with severe chronic heart failure. Thirty minutes after commencement of treatment mean cardiac index had risen by 26% and pulmonary artery wedge pressure, systemic vascular resistance and right atrial pressure had fallen by 51, 24 and 89%, respectively (p less than 0.05 for all changes). These changes were maintained for the 2 h observation period with no evidence of tolerance and were accompanied by a 17% increase in venous volume (p less than 0.01) and a 42% increase in ejection fraction (p less than 0.001) at 30 min; at 120 min the improvement in ejection fraction had been maintained and a further increase in venous volume to 38% above baseline was evident. The increase in venous volume was strongly correlated with the decrease in mean pulmonary artery wedge pressure and mean right atrial pressure at 30 min and 2 h (r = -0.80 and -0.69 for mean pulmonary artery wedge pressure, r = -0.88 and -0.56 for mean right atrial pressure). Milrinone therefore has clinically important venodilating properties, in addition to its known effects as an arterial vasodilator and a positive inotrope.
Nolan
J
J
University Department of Medicine, Royal infirmary, Edinburgh, UK.
Sanderson
A
A
Taddei
F
F
Smith
S
S
Muir
A L
AL
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D020105:Milrinone; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011728:Pyridones / Q000008:administration & dosage / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D014680:Veins / Q000187:drug effects*
D010726:Phosphodiesterase Inhibitors; D011728:Pyridones; D020105:Milrinone