[The hemodynamic effects of the combination of milrinone in heart failure refractory to treatment with dopamine, dobutamine and/or nitroprusside].
BACKGROUND
Classical treatment of advanced heart failure is mainly based on the intravenous administration of inotropic drugs and vasodilators. Phosphodiesterase-III inhibitors, drugs whose effectiveness is not affected for the beta-receptor downgrading, may be particularly helpful in patients with severe heart failure refractory to conventional treatment with dopamine, dobutamine and/or nitroprusside.


METHODS
We have analysed the hemodynamic effects of milrinone in 13 patients (11 men, 2 women, mean age 55 +/- 12 years) with advanced heart failure resistant to dopamine, dobutamine and/or nitroprusside. Basally, before milrinone was administered, mean cardiac index and pulmonary capillary wedge pressure were 1.9 +/- 0.4 l/min/m2 and 25 +/- 6 mmHg, respectively. Milrinone was administered intravenously with a initial dose of 50 micrograms/kg over 10 minutes and followed by and infusion of 0.75 micrograms/kg/min over 6 hours.


RESULTS
During milrinone administration cardiac index and stroke volume index significantly increased (40% and 28%, respectively) (p < 0.05). Furthermore, systemic and pulmonary vascular resistance indexes significantly decreased (17% and 30%, respectively) (p < 0.05). Mean right atrial pressure and pulmonary capillary wedge pressure also decreased (36% and 20%, respectively), but differences did not reach statistical significance. Milrinone was well tolerated and no patient presented serious side-effects.


CONCLUSIONS
Our results suggest that in patients with advanced heart failure refractory to conventional treatment with dopamine, dobutamine and/or nitroprusside, the addition of milrinone significantly improves parameters of systolic function.
Domínguez de Rozas
J M
JM
Departamento de Cardiología y Cirugía Cardíaca, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona.
Guindo Soldevila
J
J
Rodríguez Font
E
E
Martínez Vílchez
R
R
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004280:Dobutamine / Q000627:therapeutic use*; D004298:Dopamine / Q000627:therapeutic use*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone; D009599:Nitroprusside / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011728:Pyridones / Q000627:therapeutic use*
D010726:Phosphodiesterase Inhibitors; D011728:Pyridones; D009599:Nitroprusside; D004280:Dobutamine; D020105:Milrinone; D004298:Dopamine
Efectos hemodinámicos de la asociación de milrinona en la insuficiencia cardíaca refractaria al tratamiento con dopamina, dobutamina y/o nitroprusiato.