Abramov Dmitry, Haglund Nicholas A, Di Salvo Thomas G
Division of Cardiology, University of Louisville, 201 Abraham Flexner Way Ste 1001, Louisville, KY, 40202, USA.
Heart Failure Center, University of Kansas Health System, Kansas City, KS, USA.
Am J Cardiovasc Drugs. 2017 Aug;17(4):335-342. doi: 10.1007/s40256-017-0225-4.
Although milrinone infusion is reported to benefit left ventricular function in chronic left heart failure, few insights exist regarding its effects on pulmonary circulation and right ventricular function.
We retrospectively reviewed right heart catheterization data at baseline and during continuous infusion of milrinone in 69 patients with advanced heart failure and analyzed the effects on ventricular stroke work indices, pulmonary vascular resistance and pulmonary arterial compliance.
Compared to baseline, milrinone infusion after a mean 58 ± 61 days improved mean left ventricular stroke work index (1540 ± 656 vs. 2079 ± 919 mmHg·mL/m, p = 0.0007) to a much greater extent than right ventricular stroke work index (616 ± 346 vs. 654 ± 332, p = 0.053); however, patients with below median stroke work indices experienced a significant improvement in both left and right ventricular stroke work performance. Overall, milrinone reduced left and right ventricular filling pressures and pulmonary and systemic vascular resistance by approximately 20%. Despite an increase in pulmonary artery capacitance (2.3 ± 1.6 to 3.0 ± 2.0, p = 0.013) and a reduction in pulmonary vascular resistance (3.8 ± 2.3 to 3.0 ± 1.7 Wood units), milrinone did not reduce the transpulmonary gradient (13 ± 7 vs. 12 ± 6 mmHg, p = 0.252), the pulmonary artery pulse pressure (25 ± 10 vs. 24 ± 10, p = 0.64) or the pulmonary artery diastolic to pulmonary capillary wedge gradient (2.0 ± 6.5 vs. 2.4 ± 6.0, p = 0.353).
Milrinone improved left ventricular stroke work indices to a greater extent than right ventricular stroke work indices and had beneficial effects on right ventricular net input impedance, predominantly via augmentation of left ventricular stroke volume and passive unloading of the pulmonary circuit. Patients who had the worst biventricular performance benefited the most from chronic milrinone infusion.
尽管据报道米力农输注对慢性左心衰竭患者的左心室功能有益，但关于其对肺循环和右心室功能的影响却知之甚少。
我们回顾性分析了69例晚期心力衰竭患者在基线时和持续输注米力农期间的右心导管检查数据，并分析了其对心室每搏功指数、肺血管阻力和肺动脉顺应性的影响。
与基线相比，平均58±61天后输注米力农使平均左心室每搏功指数（1540±656 vs. 2079±919 mmHg·mL/m，p = 0.0007）改善程度远大于右心室每搏功指数（616±346 vs. 654±332，p = 0.053）；然而，每搏功指数低于中位数的患者左、右心室每搏功表现均有显著改善。总体而言，米力农使左、右心室充盈压以及肺血管和体循环血管阻力降低约20%。尽管肺动脉容量增加（2.3±1.6至3.0±2.0，p = 0.013）且肺血管阻力降低（3.8±2.3至3.0±1.7 Wood单位），但米力农并未降低跨肺压差（13±7 vs. 12±6 mmHg，p = 0.252）、肺动脉脉压（25±10 vs. 24±10，p = 0.64）或肺动脉舒张压与肺毛细血管楔压梯度（2.0±6.5 vs. 2.4±6.0，p = 0.353）。
米力农对左心室每搏功指数的改善程度大于右心室每搏功指数，并对右心室净输入阻抗有有益影响，主要是通过增加左心室每搏量和使肺循环被动卸载。双心室功能最差的患者从长期米力农输注中获益最大。
