Effect of Oral Milrinone on Mortality in Severe Chronic Heart Failure

BECAUSE cardiac contractility is impaired in patients with chronic heart failure, many drugs have been developed to enhance the inotropic state of the failing heart. 1 Some drugs increase the concentration of intracellular sodium, either by stimulating the activity of the sodium channel (sodium-channel agonists) or by inhibiting the activity of sodium/potassium—transporting ATPase (digitalis glycosides). Other positive inotropic agents increase the concentration of intracellular cyclic AMP, either by promoting its synthesis (beta-adrenergic agonists) or by retarding its degradation (phosphodiesterase inhibitors). The use of cyclic AMP—enhancing agents has been viewed as a particularly rational approach to the treatment of chronic heart failure, . . .