SURVIVAL OF PATIENTS WITH SEVERE CONGESTIVE-HEART-FAILURE TREATED WITH ORAL MILRINONE
SURVIVAL OF PATIENTS WITH SEVERE CONGESTIVE-HEART-FAILURE TREATED WITH ORAL MILRINONE
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DOI：
10.1016/s0735-1097(86)80478-8
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发表时间：
1986-03-01
影响因子：
24
通讯作者：
BRAUNWALD, E
中科院分区：
文献类型：
--
作者：
BAIM, DS;COLUCCI, WS;BRAUNWALD, E
在100例尽管接受常规治疗但仍有严重充血性心力衰竭的患者中，评价了长期口服米力农治疗的安全性和有效性，为期2年半。长期口服米力农治疗（27 . ±. 8 mg/天初始剂量）耐受性良好;仅11%的患者发生药物相关副作用，仅4%的患者停药。94例患者在治疗1个月后进行评估，51%的患者至少改善了一个纽约心脏协会功能分级。尽管血流动力学和临床改善，生命表分析显示治疗6个月时的死亡率为39%，1年时的死亡率为63%。进入研究时预测6个月内死亡的特征包括更高级的功能分级、肾功能受损、右心室射血分数降低、24小时动态心电图显示存在非持续性室性心动过速、基线血流动力学功能受损更严重以及米力农治疗1个月后无临床改善。多变量分析选择较低的基线心脏指数和主动脉收缩压作为预测死亡的最重要变量;与猝死者相比，死于进展性心力衰竭的患者在长期随访期间使用抗心律失常药物的频率较低，呋塞米和米力农剂量增加较多。因此，尽管米力农耐受性良好，并且在约一半的常规治疗难治性充血性心力衰竭患者中产生早期症状获益，但没有证据表明它改善了这种疾病的高基线死亡率。
The safety and efficacy of long-term oral milrinone therapy were evaluated over a 2 1/2 year period in 100 patients who had severe congestive heart failure despite conventional therapy. Long-term oral milrinone therapy (27 .+-. 8 mg/day initial dose) was well tolerated; drug-related side effects occurred in only 11% of patients and led to drug withdrawal in only 4% of patients. Of 94 patients evaluated after 1 month of therapy, 51% had improved by at least one New York Heart Association functional class. Despite hemodynamic and clinical improvements, life table analysis showed a 39% mortality rate at 6 months and a 63% mortality rate at 1 year of therapy. Characteristics at study entry that predicted death within 6 months included more advanced functional class, impaired renal function, lower right ventricular ejection fraction, presence of nonsustained ventricular tachycardia on 24 hour ambulatory electrocardiography, more impaired baseline hemodynamic function and absence of clinical improvement after 1 month of milrinone therapy. Multivariate analysis selected lower baseline cardiac index and aortic systolic pressure as the most significant variables in predicting death; patients who died of progressive heart failure had less frequent use of antiarrhythmic drugs and greater increases in furosemide and milrinone doses during long-term follow-up than did those who died suddenly. Thus, although milrinone is well tolerated and produces early symptomatic benefits in approximately half of patients with congestive heart failure refractory to conventional therapy, there is no evidence that it improves the high baseline mortality in this disorder.