P. Varriale et S. Ramaprasad, SHORT-TERM INTRAVENOUS MILRINONE FOR SEVERE CONGESTIVE-HEART-FAILURE - THE GOOD, BAD, AND NOT SO GOOD, Pharmacotherapy, 17(2), 1997, pp. 371-374
We evaluated the overall hemodynamic and clinical effects, beneficial
and deleterious, of short-term intravenous milrinone in the management
of severe congestive heart failure (CHF). Numerous hemodynamic measur
ements were obtained in 24 patients (mean age 65 yrs) with advanced, s
evere CHF (New York Heart Association class IV, ejection fraction 24 /- 5%), including 3 with concomitant clinical sepsis. Hemodynamic data
were recorded at baseline and after a bolus of intravenous milrinone
SO mu g/kg and maintenance infusion based on creatinine clearance at 0
.5, 3, 24 and 48 hours. Cardiac index increased and pulmonary capillar
y wedge pressure decreased significantly (p<0.001; 2.07 +/- 0.36 to 3.
6 +/- 0.36 L/min/m(2) and 20.6 +/- 4.0 to 13.5 +/- 2.8 mm Hg, respecti
vely) in 24 patients 0.5 hour after initiation of therapy: These favor
able hemodynamic responses, including significant decreases in systemi
c vascular resistance index and right atrial pressure, were sustained
throughout the 48-hour study in 19 patients (79%). Severe hypotension
occurred in three patients with superimposed sepsis as the result of e
xaggerated vasodilatation. One patient had recurrent ventricular tachy
cardia and another tolerance to milrinone. In two patients, excessive
decline in preload and fall in cardiac index were reversed with volume
expansion. Intravenous milrinone offered significant short-term hemod
ynamic benefits in most patients with severe CHF.