Intermittent milrinone effect on long-term hemodynamic profile in patientswith severe congestive heart failure

Background Many reports have suggested that intermittent milrinone infusion (IMI) may be efficacious in the management of end-stage congestive heart f ailure (CHF), but this issue has not been clearly established. The aim of o ur study was to investigate the effectiveness of IMI in hospitalized patien ts with severe CHF undergoing long-term (4 months) post-therapy hemodynamic s. Methods Thirty-six patients (28 men, 8 women; mean age 65.6 +/- 8.2 years o ld) with end-stage CHF (New York Heart Association functional class Ill-IV) were studied. Each patient received 4 cycles of 3 days per week with milri none therapy. Each cycle consisted of a loading dose of 50 mu g/kg over 10 minutes and a 72-hour continuous infusion of 0.5 mu g/kg per minute under c lose monitoring. Hemodynamic changes were determined during the first and f ourth cycles and on 4-month reexamination. Full clinical examination was pe rformed at the beginning (baseline) and at the end of 4-month follow-up. Results The values of mean pulmonary arterial pressure, pulmonary capillary wedge pressure, systemic vascular resistance, and pulmonary vascular resis tance were significantly decreased (P <.01) and cardiac index was significa ntly increased (P < .01) compared with the baseline of first and fourth cyc les. At the end of the 4-month follow-up period all hemodynamic parameters sustained the improvement. Clinical examination at the end of the 4-month p eriod showed that 21 (58.3%) of 36 patients remained in New York Heart Asso ciation functional class IV but were hemodynamically improved, 13 (36.2%) o f 36 were in functional class III, and 2 (5.5%) of 36 were in class II-III. There were no deaths during the study period. Conclusions Our findings suggest that IMI in hospitalized patients with sev ere CHF is hemodynamically efficacious. This beneficial hemodynamic effect is maintained for at least 4 months after discontinuation of therapy. These promising results raised the possibility that given appropriately, milrino ne may have an important role in end-stage CHF.