Effect of oral milrinone on end-systolic relations in patients with severe congestive heart failure.
The new inotropic agent milrinone has both vasodilator and inotropic cardiovascular effects, but the importance of these effects in patients with severe congestive heart failure (CHF) is controversial. The left ventricular (LV) end-systolic pressure-diameter relation was used to determine the independent inotropic effect of milrinone. Seven patients with New York Heart Association class III CHF were invasively monitored with right-sided heart catheters and radial arterial lines. M-mode echocardiography was used to measure LV dimensions. The effect of a 10-mg oral dose of milrinone on hemodynamic, echocardiographic and end-systolic variables was determined. End-systolic pressure was measured at the dicrotic notch of the arterial pressure tracing and end-systolic LV dimensions at the time of aortic valve closure. Methoxamine (n = 6) or nitroprusside (n = 1) was used to alter afterload so that the end-systolic pressure-diameter relation could be determined. Arterial vasodilation from milrinone was evidenced by a decrease in mean arterial blood pressure (88 +/- 5 to 77 +/- 2 mm Hg, p less than 0.025) and an increase in cardiac index (from 2.7 +/- 0.2 to 3.2 +/- 0.2 liters/min/m2, p less than 0.025), with no change in heart rate (80 +/- 5 beats/min). Milrinone decreased preload as assessed by the pulmonary artery wedge pressure (from 17 +/- 2 to 10 +/- 2 mm Hg, p less than 0.01) and end-diastolic LV diameter (from 7.4 +/- 0.4 to 7.0 +/- 0.4 cm, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)
Miller
W P
WP
Section of Cardiology, University of Wisconsin, Madison 53792.
Ark
C R
CR
Wiederholt
P
P
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000503:physiopathology*; D006334:Heart Function Tests; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008729:Methoxamine / Q000494:pharmacology; D008875:Middle Aged; D020105:Milrinone; D009599:Nitroprusside / Q000494:pharmacology; D011728:Pyridones / Q000627:therapeutic use*; D013599:Systole / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use
D002316:Cardiotonic Agents; D011728:Pyridones; D014665:Vasodilator Agents; D009599:Nitroprusside; D008729:Methoxamine; D020105:Milrinone