Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone
To elucidate the mechanisms by which the new bipyridine inotropic agent milrinone improves cardiac function, we examined multiple indexes of left ventricular diastolic function before and after administration of milrinone to patients with advanced (NYHA class III or IV) congestive heart failure. In...
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Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1984-12, Vol.70 (6), p.1030-1037 |
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creator | MONRAD, E. S MCKAY, R. G BAIM, D. S COLUCCI, W. S FIFER, M. A HELLER, G. V ROYAL, H. D GROSSMAN, W |
description | To elucidate the mechanisms by which the new bipyridine inotropic agent milrinone improves cardiac function, we examined multiple indexes of left ventricular diastolic function before and after administration of milrinone to patients with advanced (NYHA class III or IV) congestive heart failure. In 13 patients left ventricular pressure measurements were made with a micromanometer to permit assessment of peak negative dP/dt and the time constant of left ventricular isovolumic relaxation, T, before and after milrinone. In nine patients radionuclide ventriculographic studies were performed during left heart catheterization, allowing calculation of left ventricular peak filling rate, volumes, and the diastolic pressure-volume relationship before and after milrinone. After intravenous administration of milrinone, peak negative dP/dt increased (+ 18%; p less than .01) and T decreased (-30%; p less than .01), while heart rate increased by only 8% (87 +/- 12 to 94 +/- 15 beats/min; p less than .01), left ventricular systolic pressure did not change, and mean aortic pressure fell by 11% (p less than .01). Left ventricular peak filling rate increased (1.2 +/- 0.6 to 1.7 +/- 0.7 end-diastolic volumes/sec; p less than or equal to .02) despite a decrease in left ventricular filling pressure (mean pulmonary wedge pressure 27 +/- 7 to 18 +/- 9 mm Hg; p less than .01). There was a fall in left ventricular end-diastolic pressure (28.6 +/- 6 to 19 +/- 7 mm Hg; p less than or equal to .01), with no significant change in left ventricular end-diastolic volume. This was associated with a downward shift in the left ventricular diastolic pressure-volume relationship in most cases. |
doi_str_mv | 10.1161/01.CIR.70.6.1030 |
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S ; MCKAY, R. G ; BAIM, D. S ; COLUCCI, W. S ; FIFER, M. A ; HELLER, G. V ; ROYAL, H. D ; GROSSMAN, W</creator><creatorcontrib>MONRAD, E. S ; MCKAY, R. G ; BAIM, D. S ; COLUCCI, W. S ; FIFER, M. A ; HELLER, G. V ; ROYAL, H. D ; GROSSMAN, W</creatorcontrib><description>To elucidate the mechanisms by which the new bipyridine inotropic agent milrinone improves cardiac function, we examined multiple indexes of left ventricular diastolic function before and after administration of milrinone to patients with advanced (NYHA class III or IV) congestive heart failure. In 13 patients left ventricular pressure measurements were made with a micromanometer to permit assessment of peak negative dP/dt and the time constant of left ventricular isovolumic relaxation, T, before and after milrinone. In nine patients radionuclide ventriculographic studies were performed during left heart catheterization, allowing calculation of left ventricular peak filling rate, volumes, and the diastolic pressure-volume relationship before and after milrinone. After intravenous administration of milrinone, peak negative dP/dt increased (+ 18%; p less than .01) and T decreased (-30%; p less than .01), while heart rate increased by only 8% (87 +/- 12 to 94 +/- 15 beats/min; p less than .01), left ventricular systolic pressure did not change, and mean aortic pressure fell by 11% (p less than .01). Left ventricular peak filling rate increased (1.2 +/- 0.6 to 1.7 +/- 0.7 end-diastolic volumes/sec; p less than or equal to .02) despite a decrease in left ventricular filling pressure (mean pulmonary wedge pressure 27 +/- 7 to 18 +/- 9 mm Hg; p less than .01). There was a fall in left ventricular end-diastolic pressure (28.6 +/- 6 to 19 +/- 7 mm Hg; p less than or equal to .01), with no significant change in left ventricular end-diastolic volume. This was associated with a downward shift in the left ventricular diastolic pressure-volume relationship in most cases.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.70.6.1030</identifier><identifier>PMID: 6499142</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Biological and medical sciences ; Cardiac Volume - drug effects ; Cardiotonic agents ; Cardiotonic Agents - pharmacology ; Cardiotonic Agents - therapeutic use ; Cardiovascular system ; Diastole - drug effects ; Female ; Heart Failure - diagnostic imaging ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Hemodynamics - drug effects ; Humans ; Male ; Medical sciences ; Middle Aged ; Milrinone ; Myocardial Contraction - drug effects ; Pharmacology. Drug treatments ; Pyridones - pharmacology ; Pyridones - therapeutic use ; Radionuclide Imaging ; Systole - drug effects</subject><ispartof>Circulation (New York, N.Y.), 1984-12, Vol.70 (6), p.1030-1037</ispartof><rights>1985 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c406t-8bb55800ef896e4c8649504bcad8ea6c4ee679f3b4de6b6deadbb2da1cc157d33</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=9021685$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/6499142$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MONRAD, E. S</creatorcontrib><creatorcontrib>MCKAY, R. G</creatorcontrib><creatorcontrib>BAIM, D. S</creatorcontrib><creatorcontrib>COLUCCI, W. S</creatorcontrib><creatorcontrib>FIFER, M. A</creatorcontrib><creatorcontrib>HELLER, G. V</creatorcontrib><creatorcontrib>ROYAL, H. D</creatorcontrib><creatorcontrib>GROSSMAN, W</creatorcontrib><title>Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>To elucidate the mechanisms by which the new bipyridine inotropic agent milrinone improves cardiac function, we examined multiple indexes of left ventricular diastolic function before and after administration of milrinone to patients with advanced (NYHA class III or IV) congestive heart failure. In 13 patients left ventricular pressure measurements were made with a micromanometer to permit assessment of peak negative dP/dt and the time constant of left ventricular isovolumic relaxation, T, before and after milrinone. In nine patients radionuclide ventriculographic studies were performed during left heart catheterization, allowing calculation of left ventricular peak filling rate, volumes, and the diastolic pressure-volume relationship before and after milrinone. After intravenous administration of milrinone, peak negative dP/dt increased (+ 18%; p less than .01) and T decreased (-30%; p less than .01), while heart rate increased by only 8% (87 +/- 12 to 94 +/- 15 beats/min; p less than .01), left ventricular systolic pressure did not change, and mean aortic pressure fell by 11% (p less than .01). Left ventricular peak filling rate increased (1.2 +/- 0.6 to 1.7 +/- 0.7 end-diastolic volumes/sec; p less than or equal to .02) despite a decrease in left ventricular filling pressure (mean pulmonary wedge pressure 27 +/- 7 to 18 +/- 9 mm Hg; p less than .01). There was a fall in left ventricular end-diastolic pressure (28.6 +/- 6 to 19 +/- 7 mm Hg; p less than or equal to .01), with no significant change in left ventricular end-diastolic volume. This was associated with a downward shift in the left ventricular diastolic pressure-volume relationship in most cases.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiac Volume - drug effects</subject><subject>Cardiotonic agents</subject><subject>Cardiotonic Agents - pharmacology</subject><subject>Cardiotonic Agents - therapeutic use</subject><subject>Cardiovascular system</subject><subject>Diastole - drug effects</subject><subject>Female</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - physiopathology</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Milrinone</subject><subject>Myocardial Contraction - drug effects</subject><subject>Pharmacology. Drug treatments</subject><subject>Pyridones - pharmacology</subject><subject>Pyridones - therapeutic use</subject><subject>Radionuclide Imaging</subject><subject>Systole - drug effects</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1984</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kEtr3DAQgEVpSTdp770UdCi92R1ZD9vHsCTNwkIgJGchS-NGxa9IcpL--2rZZWFgGOabYeYj5BuDkjHFfgErt7uHsoZSlQw4fCAbJitRCMnbj2QDAG1R86r6TC5j_JtLxWt5QS6UaFsmqg1ZduMS5lcccUrUTzkcvmOkc0-dNzHNg7d0wdDPYTSTxQOzmOQzHumbT8_UztMfjMm_In1GExLtjR_WgDQFNAndkRr9EPw0T_iFfOrNEPHrKV-Rp9ubx-1dsb__vdte7wsrQKWi6TopGwDsm1ahsE2-WILorHENGmUFoqrbnnfCoeqUQ-O6rnKGWctk7Ti_Ij-Pe_N7L2s-UI8-WhwGM-G8Rt0wzmXFDyAcQRvmGAP2egl-NOGfZqAPkjUwnSXrGrTSB8l55Ptp99qN6M4DJ6u5_-PUN9GaoQ_ZnI9nrIWKqUby_2xqh_E</recordid><startdate>198412</startdate><enddate>198412</enddate><creator>MONRAD, E. S</creator><creator>MCKAY, R. G</creator><creator>BAIM, D. S</creator><creator>COLUCCI, W. S</creator><creator>FIFER, M. A</creator><creator>HELLER, G. V</creator><creator>ROYAL, H. D</creator><creator>GROSSMAN, W</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>198412</creationdate><title>Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone</title><author>MONRAD, E. S ; MCKAY, R. G ; BAIM, D. S ; COLUCCI, W. S ; FIFER, M. A ; HELLER, G. V ; ROYAL, H. D ; GROSSMAN, W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-8bb55800ef896e4c8649504bcad8ea6c4ee679f3b4de6b6deadbb2da1cc157d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1984</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiac Volume - drug effects</topic><topic>Cardiotonic agents</topic><topic>Cardiotonic Agents - pharmacology</topic><topic>Cardiotonic Agents - therapeutic use</topic><topic>Cardiovascular system</topic><topic>Diastole - drug effects</topic><topic>Female</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - physiopathology</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Milrinone</topic><topic>Myocardial Contraction - drug effects</topic><topic>Pharmacology. Drug treatments</topic><topic>Pyridones - pharmacology</topic><topic>Pyridones - therapeutic use</topic><topic>Radionuclide Imaging</topic><topic>Systole - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MONRAD, E. S</creatorcontrib><creatorcontrib>MCKAY, R. G</creatorcontrib><creatorcontrib>BAIM, D. S</creatorcontrib><creatorcontrib>COLUCCI, W. S</creatorcontrib><creatorcontrib>FIFER, M. A</creatorcontrib><creatorcontrib>HELLER, G. V</creatorcontrib><creatorcontrib>ROYAL, H. D</creatorcontrib><creatorcontrib>GROSSMAN, W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MONRAD, E. S</au><au>MCKAY, R. G</au><au>BAIM, D. S</au><au>COLUCCI, W. S</au><au>FIFER, M. A</au><au>HELLER, G. V</au><au>ROYAL, H. D</au><au>GROSSMAN, W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1984-12</date><risdate>1984</risdate><volume>70</volume><issue>6</issue><spage>1030</spage><epage>1037</epage><pages>1030-1037</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>To elucidate the mechanisms by which the new bipyridine inotropic agent milrinone improves cardiac function, we examined multiple indexes of left ventricular diastolic function before and after administration of milrinone to patients with advanced (NYHA class III or IV) congestive heart failure. In 13 patients left ventricular pressure measurements were made with a micromanometer to permit assessment of peak negative dP/dt and the time constant of left ventricular isovolumic relaxation, T, before and after milrinone. In nine patients radionuclide ventriculographic studies were performed during left heart catheterization, allowing calculation of left ventricular peak filling rate, volumes, and the diastolic pressure-volume relationship before and after milrinone. After intravenous administration of milrinone, peak negative dP/dt increased (+ 18%; p less than .01) and T decreased (-30%; p less than .01), while heart rate increased by only 8% (87 +/- 12 to 94 +/- 15 beats/min; p less than .01), left ventricular systolic pressure did not change, and mean aortic pressure fell by 11% (p less than .01). Left ventricular peak filling rate increased (1.2 +/- 0.6 to 1.7 +/- 0.7 end-diastolic volumes/sec; p less than or equal to .02) despite a decrease in left ventricular filling pressure (mean pulmonary wedge pressure 27 +/- 7 to 18 +/- 9 mm Hg; p less than .01). There was a fall in left ventricular end-diastolic pressure (28.6 +/- 6 to 19 +/- 7 mm Hg; p less than or equal to .01), with no significant change in left ventricular end-diastolic volume. This was associated with a downward shift in the left ventricular diastolic pressure-volume relationship in most cases.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>6499142</pmid><doi>10.1161/01.CIR.70.6.1030</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Biological and medical sciences Cardiac Volume - drug effects Cardiotonic agents Cardiotonic Agents - pharmacology Cardiotonic Agents - therapeutic use Cardiovascular system Diastole - drug effects Female Heart Failure - diagnostic imaging Heart Failure - drug therapy Heart Failure - physiopathology Hemodynamics - drug effects Humans Male Medical sciences Middle Aged Milrinone Myocardial Contraction - drug effects Pharmacology. Drug treatments Pyridones - pharmacology Pyridones - therapeutic use Radionuclide Imaging Systole - drug effects |
title | Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone |
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