title: Low-dose β-blocker in combination with milrinone safely improves cardiac function and eliminates pulsus alternans in patients with acute decompensated heart failure.
abstract: BACKGROUND
  The purpose of this study was to determine whether a low-dose β-blocker, in combination with milrinone, improves cardiac function in acute decompensated heart failure (ADHF) with tachycardia.
  
  
  RESULTS
  Twenty ADHF patients (New York Heart Association classification III, n=1, and IV, n=19; heart rate [HR], 107±12 beats/min; left ventricular ejection fraction, 24±7%; cardiac index [CI], 2.2±0.6 L·min(-1)·m(-2); pulmonary capillary wedge pressure [PCWP], 26±8 mmHg) were enrolled in this study. The patients first underwent conventional therapy with milrinone, vasodilators and diuretics; landiolol (1.5-6.0 µg·kg(-1)·min(-1); i.v.), which is an ultra-short-acting β(1)-selective blocker, was then added to the treatment regimen to study its effect on hemodynamics. Low-dose landiolol (1.5 µg·kg(-1)·min(-1)) significantly reduced HR by 11% without changing blood pressure (BP) and CI, whereas higher doses (≥3.0 µg·kg(-1)·min(-1)) tended to decrease BP and CI while increasing PCWP and systemic vascular resistance. After treatment with landiolol (1.5 µg·kg(-1)·min(-1)), hemodynamic parameters such as PCWP, stroke volume index, SvO(2), rate pressure product, filling time/RR, E/e', and Tei index were significantly improved.
  
  
  CONCLUSIONS
  A low-dose β-blocker in combination with milrinone improved cardiac function in ADHF patients with tachycardia; therefore, it may be considered as an adjunct therapy for use when standard therapy with milrinone is not effective at slowing HR.
authors.affiliation: Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan. skoba@yamaguchi-u.ac.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takehisa
authors.initials: T
authors.lastname: Susa
authors.forename: Takeo
authors.initials: T
authors.lastname: Tanaka
authors.forename: Wakako
authors.initials: W
authors.lastname: Murakami
authors.forename: Seiko
authors.initials: S
authors.lastname: Fukuta
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okuda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Doi
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Wada
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nao
authors.forename: Jutaro
authors.initials: J
authors.lastname: Yamada
authors.forename: Takayuki
authors.initials: T
authors.lastname: Okamura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yano
authors.forename: Masunori
authors.initials: M
authors.lastname: Matsuzaki
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage*; D009025:Morpholines / Q000008:administration & dosage*; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D009025:Morpholines; C077049:landiolol; D014508:Urea; D020105:Milrinone