Piscione F, Jaski B E, Serruys P W
Catheterization Laboratory, Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
J Cardiovasc Pharmacol. 1988 Mar;11(3):258-69. doi: 10.1097/00005344-198803000-00002.
Systemic and coronary hemodynamics were measured before and every 10 min after oral milrinone (10 mg) administration for 50 min, together with the drug plasma level in 14 patients with congestive heart failure. Left ventricular pressure (tip manometry), volume (angiography), and derived indexes were simultaneously assessed before and 60 min after milrinone treatment. Peak positive dP/dt, Vmax, and peak velocity of contractile element significantly increased 30 min after milrinone administration by 15%, 37%, and 30%, respectively. An increase in cardiac output (25%) with a consistent decrease in systemic vascular resistance (20%) occurred after 40 min without major changes in heart rate and aortic pressure. Right atrial pressure and minimal and end-diastolic left ventricular pressures decreased significantly after 50 min, by 30%, 25%, and 20%, respectively. Peak -dP/dt increased despite a slight change in end-systolic pressure. The time constants of relaxation, tau 1 and tau 2, significantly decreased by 15% after 50 min and by 16%. A transient but significant increase of 40% in coronary sinus blood flow was observed after 30 min, while myocardial oxygen consumption was unchanged 50 min after milrinone treatment. No changes were observed in catecholamine balance with milrinone. Ejection fraction increased significantly (22%) after milrinone administration, as well as the net work of left ventricle (27%). The increase of inotropism in failing hearts with a parallel reduction in preload and afterload makes milrinone a drug potentially useful in the oral treatment of severe heart failure.
对14例充血性心力衰竭患者，在口服米力农（10mg）前及给药后50分钟内每隔10分钟测量全身和冠状动脉血流动力学，并检测血浆药物浓度。在米力农治疗前及治疗后60分钟，同时评估左心室压力（顶端测压法）、容积（血管造影）及衍生指标。米力农给药30分钟后，峰值正性dP/dt、Vmax和收缩成分峰值速度分别显著增加15%、37%和30%。40分钟后心输出量增加（25%），全身血管阻力持续降低（20%），心率和主动脉压力无明显变化。50分钟后，右心房压力、左心室最小舒张末期压力和舒张末期压力分别显著降低30%、25%和20%。尽管收缩末期压力略有变化，但峰值 -dP/dt增加。松弛时间常数tau 1和tau 2在50分钟后显著降低15%，在60分钟后降低16%。给药30分钟后观察到冠状窦血流量短暂但显著增加40%，而米力农治疗50分钟后心肌耗氧量未改变。米力农对儿茶酚胺平衡无影响。米力农给药后射血分数显著增加（22%），左心室做功也增加（27%）。衰竭心脏中强心作用增强，同时前负荷和后负荷平行降低，使得米力农成为一种可能用于口服治疗严重心力衰竭的药物。
