Effect of bolus milrinone on hemodynamic variables and pulmonary vascular resistance in patients with severe left ventricular dysfunction: A rapid test for reversibility of pulmonary hypertension
Effect of bolus milrinone on hemodynamic variables and pulmonary vascular resistance in patients with severe left ventricular dysfunction: A rapid test for reversibility of pulmonary hypertension
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DOI：
10.1016/s0735-1097(96)00399-3
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发表时间：
1996-12-01
影响因子：
24
通讯作者：
Colucci, WS
中科院分区：
文献类型：
--
作者：
Givertz, MM;Hare, JM;Colucci, WS
目标。为了探讨在心脏移植前使用米力农检测肺血管反应性的可行性，我们验证了米力农可降低严重心力衰竭患者肺血管阻力(PVR)的假设，背景固定性肺动脉高压是原位心脏移植后右心衰竭和死亡的危险因素，硝普钠是移植前最常用的检测肺动脉高压可逆性的药物，需要剂量滴定且往往受到低血压的限制，米力农是一种静脉注射活性磷酸二酯酶抑制剂，对心力衰竭患者具有正性肌力和直接血管扩张作用，尚未测试米力农降低心力衰竭患者肺血管阻力的能力。对27例心功能III级或TV级心衰患者行心脏移植，PVR大于或等于200dynes-S-cm(-5)，我们测量了单次静脉滴注米力农(50 mg/kg体重)1分钟后的血流动力学反应。米力农降低PVR的作用在给药后5~10min达到最大值，持续至少20min，5min时PVR降低31+/-4%，心输出量增加42+/-4%，平均肺动脉和肺动脉楔压分别降低12+/-4%和16+/-5%，但跨肺压梯度无明显变化，米力农对心率和体动脉压无影响，PVR降低的幅度与米力农引起的心输出量增加呈负相关。米力农持续降低严重心力衰竭继发的肺动脉高压患者的PVR，这种效果起效快，耐受性好，即使是体动脉压较低的患者，静脉注射米力农也可以用来测试接受心脏移植评估的心力衰竭患者的肺动脉高压可逆性。(C)1996年，由美国心脏病学会
Objectives. To examine the feasibility of using milrinone to test pulmonary vascular reactivity in patients before heart transplantation, we tested the hypothesis that milrinone would lower pulmonary vascular resistance (PVR) in patients with severe heart failure,Background Fixed pulmonary hypertension is a risk factor for right heart failure and death after orthotopic heart transplantation, Sodium nitroprusside, the agent used most commonly to test for reversibility of pulmonary hypertension before transplantation, requires dose titration and is frequently limited by hypotension, Milrinone is an intravenously active phosphodiesterase inhibitor that acts rapidly and exerts both positive inotropic and direct vasodilator effects in patients with heart failure, The ability of milrinone to lower PVR in patients with heart failure has not been tested,Methods. In 27 patients with New York Heart Association functional class III or TV heart failure referred for heart transplantation with a PVR greater than or equal to 200 dynes-s-cm(-5), we measured the hemodynamic response to a single intravenous bolus of milrinone (50 mu g/kg body weight) infused over 1 min.Results. Milrinone decreased PVR in all patients, The effect was maximal 5 to 10 min after the bolus and persisted for at least 20 min, The reduction in PVR at 5 min ([mean +/- SEM] 31 +/- 4%) was associated with a 42 +/- 4% increase in cardiac output and decreases of 12 +/- 4% and 16 +/- 5% in mean pulmonary artery and pulmonary artery wedge pressures, respectively, but no change in transpulmonary pressure gradient, Milrinone had no effect on heart rate or systemic arterial pressure, The magnitude of the decrease in PVR correlated inversely with the milrinone-induced increase in cardiac output.Conclusions. Bolus milrinone consistently decreases PVR in patients with pulmonary hypertension secondary to severe heart failure, This effect is rapid in onset and well tolerated, even by patients with low systemic arterial pressure, An intravenous bolus of milrinone can be used to test for the reversibility of pulmonary hypertension in patients with heart failure undergoing evaluation for heart transplantation. (C) 1996 by the American College of Cardiology