TY - JOUR
T1 - Systemic and coronary effects of intravenous milrinone and dobutamine in congestive heart failure
AU - Grose, Richard
AU - Strain, Janet
AU - Greenberg, Mark
AU - LeJemtel, Thierry H.
PY - 1986
Y1 - 1986
N2 - The effects of dobutamine and intravenous milrinone on systemic hemodynamics, coronary blood flow and myocardial metabolism were studied in 11 patients with severe congestive heart failure. Although milrinone and dobutamine similarly increased cardiac index from 1.9 ± 0.4 to 2.5 ± 0.4 liters/min per m2 (p < 0.001) and from 1.9 ± 0.4 to 2.8 ± 0.8 liters/min per m2 (p < 0.001), respectively, milrinone decreased left ventricular end-diastolic pressure to a greater extent than dobutamine, that is, from 26 ± 6 to 12 ± 8 mm Hg (p < 0.001) versus 26 ± 8 to 20 ± 8 mm Hg (p < 0.001). In contrast to dobutamine, milrinone significantly reduced mean systemic arterial and right atrial pressures. Dobutamine increased the first derivative of left ventricular pressure (dP/dt) from 1,013 ± 309 to 1,360 ± 538 mm Hg/s (p < 0.01) but milrinone did not. Similarly, blood flow and myocardial oxygen consumption were increased by dobutamine from 152 ± 87 to 187 ± 118 ml/min (p < 0.05) and from 17.7 ± 10.9 to 21.5 ± 14.9 ml O2/min (p < 0.05), respectively, but were unchanged by milrinone. Both drugs significantly decreased coronary vascular resistance and myocardial oxygen extraction but did not change myocardial lactate extraction. Thus, dobutamine and milrinone produce similar improvement in cardiac index. However, dobutamine increases myocardial oxygen consumption, whereas milrinone does not. This difference can probably be explained by the substantial vasodilating properties of milrinone.
AB - The effects of dobutamine and intravenous milrinone on systemic hemodynamics, coronary blood flow and myocardial metabolism were studied in 11 patients with severe congestive heart failure. Although milrinone and dobutamine similarly increased cardiac index from 1.9 ± 0.4 to 2.5 ± 0.4 liters/min per m2 (p < 0.001) and from 1.9 ± 0.4 to 2.8 ± 0.8 liters/min per m2 (p < 0.001), respectively, milrinone decreased left ventricular end-diastolic pressure to a greater extent than dobutamine, that is, from 26 ± 6 to 12 ± 8 mm Hg (p < 0.001) versus 26 ± 8 to 20 ± 8 mm Hg (p < 0.001). In contrast to dobutamine, milrinone significantly reduced mean systemic arterial and right atrial pressures. Dobutamine increased the first derivative of left ventricular pressure (dP/dt) from 1,013 ± 309 to 1,360 ± 538 mm Hg/s (p < 0.01) but milrinone did not. Similarly, blood flow and myocardial oxygen consumption were increased by dobutamine from 152 ± 87 to 187 ± 118 ml/min (p < 0.05) and from 17.7 ± 10.9 to 21.5 ± 14.9 ml O2/min (p < 0.05), respectively, but were unchanged by milrinone. Both drugs significantly decreased coronary vascular resistance and myocardial oxygen extraction but did not change myocardial lactate extraction. Thus, dobutamine and milrinone produce similar improvement in cardiac index. However, dobutamine increases myocardial oxygen consumption, whereas milrinone does not. This difference can probably be explained by the substantial vasodilating properties of milrinone.
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U2 - 10.1016/S0735-1097(86)80231-5
DO - 10.1016/S0735-1097(86)80231-5
M3 - Article
C2 - 3958369
AN - SCOPUS:0022577626
SN - 0735-1097
VL - 7
SP - 1107
EP - 1113
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -