HEMODYNAMIC-EFFECT OF AMRINONE DEPENDS ON PRETREATMENT VASCULAR-RESISTANCE IN PATIENTS WITH EVOLVING CONGESTIVE-HEART-FAILURE - CORRELATIONBETWEEN VASCULAR-RESISTANCE AND NEUROHORMONAL ACTIVITY

We investigated the hemodynamic effects of amrinone and assessed its e ffects on neurohormonal factors in 15 patients with evolving congestiv e heart failure with various origins. We serially determined the pulmo nary and systemic vascular-resistance indices after amrinone infusion and examined the relation between changes in hemodynamic parameters an d changes in concentrations of norepinephrine, atrial natriuretic pept ide, angiotensin II, and endothelin-l in the pulmonary capillary wedge region (PCWR) and in the peripheral veins. Amrinone significantly red uced pulmonary vascular-resistance index (PVRI; Wood x m(2)) in patien ts with high PVRI (greater than or equal to 15) before the infusion, s ignificantly reduced systemic vascular-resistance index (SVRI; Wood x m(2)) in patients with high SVRI (greater than or equal to 50) before the infusion, and had little effect on vascular resistances in patient s with low PVRI(<15) and low SVRI(<50). The reduction in PVRI was corr elated with the reduction in the endothelin-l level (r=0.75) in the PC WR, and the reduction in SVRI with norepinephrine level (r=0.70) in th e peripheral veins, The angiotensin II level did not change throughout the study. These findings suggest that amrinone had selective hemodyn amic effects on pulmonary and systemic circulations with neurohormonal effects, according to PVRI and SVRI before infusion.