Circulation, Vol 70, 1030-1037, Copyright © 1984 by American Heart Association
ES Monrad, RG McKay, DS Baim, WS Colucci, MA Fifer, GV Heller, HD Royal and W Grossman
To elucidate the mechanisms by which the new bipyridine inotropic agent
milrinone improves cardiac function, we examined multiple indexes of left
ventricular diastolic function before and after administration of milrinone
to patients with advanced (NYHA class III or IV) congestive heart failure.
In 13 patients left ventricular pressure measurements were made with a
micromanometer to permit assessment of peak negative dP/dt and the time
constant of left ventricular isovolumic relaxation, T, before and after
milrinone. In nine patients radionuclide ventriculographic studies were
performed during left heart catheterization, allowing calculation of left
ventricular peak filling rate, volumes, and the diastolic pressure-volume
relationship before and after milrinone. After intravenous administration
of milrinone, peak negative dP/dt increased (+ 18%; p less than .01) and T
decreased (-30%; p less than .01), while heart rate increased by only 8%
(87 +/- 12 to 94 +/- 15 beats/min; p less than .01), left ventricular
systolic pressure did not change, and mean aortic pressure fell by 11% (p
less than .01). Left ventricular peak filling rate increased (1.2 +/- 0.6
to 1.7 +/- 0.7 end-diastolic volumes/sec; p less than or equal to .02)
despite a decrease in left ventricular filling pressure (mean pulmonary
wedge pressure 27 +/- 7 to 18 +/- 9 mm Hg; p less than .01). There was a
fall in left ventricular end-diastolic pressure (28.6 +/- 6 to 19 +/- 7 mm
Hg; p less than or equal to .01), with no significant change in left
ventricular end-diastolic volume. This was associated with a downward shift
in the left ventricular diastolic pressure-volume relationship in most
cases.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone
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