[The effect of hemodynamic changes in 24-hour milrinone infusion on sympathetic activity and the renin-angiotensin-aldosterone system in patients with severe heart failure].
The hemodynamics of 18 patients (subgroup A) with severe heart failure (baseline Cl less than or equal to 1.55 l.min-1.m-2), including three patients with cardiogenic shock, and another 22 patients (subgroup B) with moderate heart failure (baseline Cl from 1.55 to 2.5 l.min-1.m-2) were investigated during a 24 h milrinone infusion, combined with investigation of the response of the sympathetic tone (plasma catecholamine levels) and the renin-angiotensin-aldosterone system to the hemodynamic improvement in both subgroups. Cl increased (p less than or equal to 0.001) to 162.7% after 5 min and further to 206.4% of baseline after 30 min of milrinone therapy in subgroup A, and in B to 139.3% and further to 146.4% after 15 min. PCWP decreased (p less than or equal to 0.001) to 83.8% and further to 65.5% of baseline after 30 min in subgroup A, and to 58.4% in subgroup B. Heart rate decreased (p less than or equal to 0.05) from 99.4 to 94.7 bpm in A and showed a decreasing tendency in B. MAP rose in A from 75.5 to 79.4 after 1 h and further to 83.3 mm Hg (p less than or equal to 0.01) after 24 h; in subgroup B, MAP did not change. Plasma noradrenaline level decreased (p less than or equal to 0.001) in A from 1419.5 (B: 782.9) to 838.2 (B: 529.6) after 1 h and further to 655.1 (B: 467.9) pg/ml after 24 h. Plasma renin decreased (p less than or equal to 0.01) in A from 1047.6 (B: 460.2) to 597.4 (B: 222.5) and further to 392.6 (B: 191.7) microU/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
Mager
G
G
Klinik III für Innere Medizin Universität zu Köln.
Steffen
H M
HM
Klocke
R K
RK
Wambach
G
G
Kux
A
A
Degenhardt
S
S
Höpp
H W
HW
Hilger
H H
HH
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy / Q000503:physiopathology; D002316:Cardiotonic Agents; D002395:Catecholamines / Q000097:blood; D003327:Coronary Disease / Q000188:drug therapy / Q000503:physiopathology; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020105:Milrinone; D011728:Pyridones / Q000008:administration & dosage*; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D013564:Sympathetic Nervous System / Q000187:drug effects* / Q000503:physiopathology
D002316:Cardiotonic Agents; D002395:Catecholamines; D011728:Pyridones; D020105:Milrinone
Auswirkung der hämodynamischen Veränderungen unter 24stündiger Milrinon-Infusion auf die sympathische Aktivität und das Renin-Angiotensin-Aldosteron-System bei Patienten mit schwerer Herzinsuffizienz.