Predictors of clinical outcome in advanced heart failure patients on continuous intravenous milrinone therapy.
Home-based milrinone therapy (HMT) is used as a bridge to cardiac transplant (CT). The safety, efficacy, and predictors of success of HMT were assessed. Forty-five patients with heart failure, referred for CT, were prospectively studied. After initial assessment, low-dose milrinone was titrated based on clinical response. Hemodynamic status was then reevaluated. Thirty-nine patients were discharged on HMT. Patients needing a left ventricular assist device (LVAD) despite milrinone (group I) and those not requiring LVAD (group II) were compared. Six of the 45 patients were ineligible for CT; 16 of 39 required LVAD as a bridge to CT despite milrinone (group I); 23 were stable on milrinone and did not require LVAD (group II). Group I was younger than group II (mean age 38.4 +/- 14.5 years vs. 57.3 +/- 5.9 years, p < 0.001). Initial acute response to intravenous milrinone [e.g., fall in the PCWP (-10.7 +/- 9.5 vs. -2.7 +/- 10.4, p = 0.02), rise in pulmonary artery oxygen saturations (16.5 +/- 8.7 vs. 7.3 +/- 10.9, p = 0.05)] was significantly better in group II than in group I. Acute hemodynamic response to milrinone predicts success of HMT as a bridge to CT.
Bhat
Geetha
G
Heart Failure & Cardiac Transplant Center, Jewish Hospital, Louisville, Kentucky, USA.
D000328:Adult; D000367:Age Factors; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006699:Home Care Services; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage* / Q000009:adverse effects; D010045:Outpatients; D010100:Oxygen / Q000097:blood; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D020105:Milrinone; D010100:Oxygen