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Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol.

Abstract：

OBJECTIVE:To compare the efficacy of milrinone and dobutamine in patients chronically treated with carvedilol. BACKGROUND:Milrinone and dobutamine are used to manage decompensated heart failure, but their efficacy in patients on beta-blocker therapy was unknown. METHODS:Twenty patients with decompensated heart failure were prospectively enrolled. Inotropic responses to milrinone (12.5, 25 or 50 microg/kg bolus infusions) or dobutamine (5, 10, 15 or 20 microg/kg/min infusions) were evaluated by right-heart catheterization. RESULTS:Milrinone increased cardiac index (2.0-2.6 l/min/m2, P=0.0001) without significantly altering heart rate (70-75 bpm, P=0.19). Milrinone decreased mean pulmonary artery pressure (36-29 mm Hg, P=0.0001), pulmonary capillary wedge pressure (24-18 mm Hg, P=0.0001) and mean arterial blood pressure (78-75 mm Hg, P=0.0002). Left ventricular stroke volume index increased in the milrinone group (31-35 ml/beat/m2, P=0.0001). Dobutamine produced an increase in cardiac index (2.4-3.3 l/min/m2, P=0.0001) only at doses that are not typically used to treat heart failure (15-20 microg/kg/min). At these doses, dobutamine increased heart rate (68-82 bpm, P=0.008), mean systemic pressure (90-117 mm Hg, P=0.0001) and mean pulmonary artery pressure (21-30 mm Hg, P=0.001). Dobutamine did not alter left ventricular stroke volume index or pulmonary capillary wedge pressure. CONCLUSIONS:Dobutamine and milrinone have different hemodynamic effects in patients treated chronically with carvedilol. These differences should be considered when selecting inotropic therapy for decompensated heart failure.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Lowes BD,Tsvetkova T,Eichhorn EJ,Gilbert EM,Bristow MR

doi

10.1016/s0167-5273(01)00520-4

subject

Has Abstract

pub_date

2001-12-01 00:00:00

pages

141-9

issue

2-3

eissn

0167-5273

issn

1874-1754

pii

S0167527301005204

journal_volume

81

pub_type

杂志文章,多中心研究

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