Evaluation of a new bipyridine inotropic agent - milrinone - in patients with severe congestive heart failure

D. S. Baim, A. V. McDowell, J. Cherniles, E. Scott Monrad, J. A. Parker, J. Edelson, E. Braunwald, W. Grossman

Research output: Contribution to journalArticle

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Abstract

Milrinone, a derivative of amrinone, has nearly 20 times the inotropic potency of the parent compound and does not cause fever or thrombocytopenia in normal volunteers or in animals sensitive to amrinone. In 20 patients with severe congestive heart failure, intravenous milrinone resulted in significant decreases in left ventricular end-diastolic pressure (from 27±2 to 18±2 mm Hg), pulmonary wedge pressure, right atrial pressure, and systemic vascular resistance, as well as a slight reduction in mean arterial pressure. Significant increases occurred in cardiac index (from 1.9±0.1 to 2.9±0.2 liters per minute per square meter) and the peak positive first derivative of left ventricular pressure, with a slight increase in heart rate. Hemodynamic improvement was sustained during a 24-hour continuous infusion. Nineteen of the 20 patients subsequently received oral milrinone (29±2 mg per day) for up to 11 months (mean, 6.0±0.8), with sustained improvement in symptoms of heart failure. In 10 patients receiving long-term oral milrinone (≥6 months) radionuclide ventriculography showed continued responsiveness, with a 27% increase in left ventricular ejection fraction after 7.5 mg of the drug. Four patients died after a mean of 4.8 months of therapy, and 3 patients with severe underlying coronary-artery disease and angina pectoris required additional antianginal therapy. No patient had fever, thrombocytopenia, gastrointestinal intolerance, or aggravation of ventricular ectopy. We conclude that milrinone shows promise for the long-term treatment of congestive heart failure.

Original languageEnglish (US)
Pages (from-to)748-756
Number of pages9
JournalNew England Journal of Medicine
Volume309
Issue number13
StatePublished - 1983
Externally publishedYes

Fingerprint

Milrinone
Heart Failure
Amrinone
Thrombocytopenia
Fever
Radionuclide Ventriculography
Pulmonary Wedge Pressure
Atrial Pressure
Angina Pectoris
Ventricular Pressure
Vascular Resistance
Stroke Volume
Coronary Artery Disease
Healthy Volunteers
Arterial Pressure
Therapeutics
Heart Rate
Hemodynamics
Blood Pressure
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Baim, D. S., McDowell, A. V., Cherniles, J., Monrad, E. S., Parker, J. A., Edelson, J., ... Grossman, W. (1983). Evaluation of a new bipyridine inotropic agent - milrinone - in patients with severe congestive heart failure. New England Journal of Medicine, 309(13), 748-756.

Evaluation of a new bipyridine inotropic agent - milrinone - in patients with severe congestive heart failure. / Baim, D. S.; McDowell, A. V.; Cherniles, J.; Monrad, E. Scott; Parker, J. A.; Edelson, J.; Braunwald, E.; Grossman, W.

In: New England Journal of Medicine, Vol. 309, No. 13, 1983, p. 748-756.

Research output: Contribution to journalArticle

Baim, DS, McDowell, AV, Cherniles, J, Monrad, ES, Parker, JA, Edelson, J, Braunwald, E & Grossman, W 1983, 'Evaluation of a new bipyridine inotropic agent - milrinone - in patients with severe congestive heart failure', New England Journal of Medicine, vol. 309, no. 13, pp. 748-756.
Baim, D. S. ; McDowell, A. V. ; Cherniles, J. ; Monrad, E. Scott ; Parker, J. A. ; Edelson, J. ; Braunwald, E. ; Grossman, W. / Evaluation of a new bipyridine inotropic agent - milrinone - in patients with severe congestive heart failure. In: New England Journal of Medicine. 1983 ; Vol. 309, No. 13. pp. 748-756.
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