Piscione F, Jaski B E, Wenting G J, Serruys P W
Cardiac Catheterization Laboratory, Erasmus University, Rotterdam, The Netherlands.
J Am Coll Cardiol. 1987 Dec;10(6):1294-302. doi: 10.1016/s0735-1097(87)80134-1.
In 14 patients with severe congestive heart failure, left ventricular pressure (measured by tip manometer) and derived variables were measured before and every 10 minutes after administration of oral milrinone (10 mg) for 50 minutes along with measurements of coronary sinus blood flow and drug plasma levels. Arterial and coronary sinus catecholamines were measured only before and 50 minutes after milrinone. Left ventricular pressure, volume (as determined by angiography) and derived indexes were simultaneously assessed at matched atrial paced heart rate before and 60 minutes after milrinone. Three patients who did not achieve a therapeutic plasma level (less than 150 ng/ml) were excluded. Peak negative first derivative of left ventricular pressure (-dP/dt) progressively and significantly increased (10%) together with a decrease in the two exponential time constants of relaxation, namely, Tau 1 (19%) and Tau 2 (22%), which represent the fit for and after the first 40 ms, respectively. Coronary flow significantly increased by 43% within 30 minutes, whereas the decrease (-13%) in coronary vascular resistance failed to be statistically significant. No change occurred in catecholamine concentrations after milrinone. Peak filling rate significantly increased by 15%. Pressure-volume curves showed a leftward and, in four patients, a downward shift; a significant decrease in minimal left ventricular diastolic and end-diastolic pressures (by 55 and 38%, respectively) and in end-diastolic volume (18%) occurred. The constant of elastic chamber stiffness measured by the simple elastic model tended to decrease, but failed to achieve a statistically significant level. Thus, oral milrinone improved left ventricular early relaxation and filling as well as chamber distensibility. This global improvement of diastolic function makes milrinone a potentially useful drug in the oral treatment of heart failure.
在14例严重充血性心力衰竭患者中，在口服米力农（10毫克）前及给药后50分钟内每隔10分钟测量左心室压力（通过顶端压力计测量）及相关变量，同时测量冠状窦血流量和药物血浆水平。仅在米力农给药前和给药后50分钟测量动脉和冠状窦儿茶酚胺。在米力农给药前和给药后60分钟，在匹配的心房起搏心率下同时评估左心室压力、容积（通过血管造影确定）及相关指标。排除3例未达到治疗性血浆水平（低于150纳克/毫升）的患者。左心室压力的最大负一阶导数（-dP/dt）逐渐且显著增加（10%），同时两个舒张时间常数即Tau 1（19%）和Tau 2（22%）减小，Tau 1和Tau 2分别代表前40毫秒及之后的拟合情况。冠状窦血流量在30分钟内显著增加43%，而冠状血管阻力的降低（-13%）无统计学意义。米力农给药后儿茶酚胺浓度无变化。最大充盈率显著增加15%。压力-容积曲线向左移位，4例患者曲线向下移位；左心室最小舒张压和舒张末期压力显著降低（分别降低55%和38%），舒张末期容积降低（18%）。通过简单弹性模型测量的弹性腔室硬度常数有降低趋势，但未达到统计学显著水平。因此，口服米力农改善了左心室早期舒张和充盈以及腔室扩张性。舒张功能的这种整体改善使米力农成为心力衰竭口服治疗中一种潜在有用的药物。
