EFFECTS OF INTRAVENOUS MILRINONE FOLLOWED BY TITRATION OF HIGH-DOSE ORAL VASODILATOR THERAPY ON CLINICAL OUTCOME AND REHOSPITALIZATION RATES IN PATIENTS WITH SEVERE HEART-FAILURE

This study evaluated the efficacy of intravenous milrinone in improvin g hemodynamics and facilitating the titration of high-dose oral vasodi lator therapy to improve clinical status. Fourteen patients (mean age 52 +/- 12 years) with severe heart failure and a left ventricular ejec tion fraction of 18 +/- 6% underwent right-side heart catheterization and an intravenous milrinone infusion followed by titration of oral va sodilator and diuretic therapy. Milrinone significantly (p <0.05) impr oved right atrial pressure (12 +/- 5 to 8 +/- 5 mm Hg), pulmonary capi llary wedge pressure (23 +/- 7 to 15 +/- 7 mm Hg), cardiac index (1.9 +/- 0.4 to 3.4 +/- 0.5 L/min/m(2)), systemic vascular resistance (1,80 9 +/- 526 to 891 +/- 144 dynes/s/cm(-5)), and pulmonary vascular resis tance (285 +/- 151 to 163 +/- 68 dynes/s/cm(-5)), which was maintained in 10 patients with titration of high-dose oral vasodilator therapy. Oral angiotensin-converting enzyme inhibitor and diuretic doses were i ncreased 318% and 89%, respectively. Four patients also received hydra lazine to optimize hemodynamics. New York Heart Association functional class improved from 3.8 +/- 0.4 to 2.6 +/- 0.6 following therapy. Ten patients who responded to therapy had fewer hospitalized days during the subsequent year compared with the year before treatment (4 +/- 17 vs 17 +/- 15), and no patient died. In contrast, the 3 patients who re sponded poorly to therapy tended to have more hospitalized days at 12 months compared with pretreatment (31 +/- 11 vs 20 +/- 18; NS); 1 pati ent died. We conclude that intravenous milrinone followed by optimizat ion of oral medical therapy may be used as a therapeutic trial to iden tify patients in need of cardiac transplantation. (C)1998 by Excerpta Medica, Inc.