Beneficial effects of intermittent home administration of the inotrope/vasodilator milrinone in patients with end-stage congestive heart failure: A preliminary study☆,☆☆,★
Section snippets
Patients
Patients with late-stage CHF who continued to have symptoms at rest despite maximal outpatient medical therapy were screened. Each prospective subject signed an informed consent for 3 days of inpatient milrinone infusion under close monitoring in the intensive care unit. Patients who demonstrated hemodynamic and symptomatic improvement without adverse side effects were offered participation in the study. All patients considered for the study had symptoms at rest or with minimal exertion.
Ten
Hospital infusions
Three patients initially screened showed either no sustained effects of milrinone (one patient) or adverse effects, including tachycardia (one patient) and arrhythmia (one patient).
The data from the initial hospitalizations for milrinone infusion are summarized in Table I. The mean cardiac output increased from 4.1 ± 0.4 L/min at baseline to a maximum of 5.5 ± 0.3 L/min (p < 0.001). Mean PAWP decreased from 23.8 ± 2.6 mm Hg to 15.2 ± 1.7 mm Hg (p = 0.002), and mixed venous oxygen saturation
Discussion
Because inotropes have been useful therapeutic agents for CHF exacerbations for more than a decade, attempts have been made to institute their use on an outpatient basis. The majority of these trials have used the synthetic β-1 agonist dobutamine. Although studies have shown improvement in cardiac index, New York Heart Association functional class and systemic vascular resistance,17, 18, 19 the initial excitement over the potential use of these drugs in an outpatients basis has considerably
Acknowledgements
We thank Steven Carter for technological support and Dr. Ralph Shabetai for his continued encouragement and support.
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From the Division of Cardiology, Veterans Affairs Medical Center, and University of California, San Diego.
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Reprint requests: Alan Maisel, MD, VAMC Cardiology 111-A, 3350 La Jolla Village Dr., San Diego, CA 921161.
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