December 21, 1978
View Full PaperHemodynamic Assessment of Amrinone
Structured PICO
Does intravenous amrinone improve immediate hemodynamic parameters in patients with congestive heart failure already receiving digitalis?
P
Population
8 patients with congestive heart failure already receiving full doses of digitalis
I
Intervention
Amrinone (1.85 to 3.5 mg per kilogram given intravenously)
O
Outcome
Immediate hemodynamic responses assessed by cardiac catheterization (cardiac index, peak rate of left ventricular pressure rise, left ventricular end-diastolic pressure, pulmonary-capillary pressure, right atrial pressure)surrogate
Intravenous amrinone produces immediate and significant hemodynamic improvements in patients with congestive heart failure already treated with digitalis.
Abstract
Amrinone, a new bipyridine derivative, exerts a positive inotropic action in experimental preparations and is effective when administered orally to dogs. To assess its immediate effects in man, we studied by cardiac catheterization the hemodynamic responses to amrinone (1.85 to 3.5 mg per kilogram given intravenously) in eight patients with congestive heart failure already receiving full doses of digitalis. The following statistically significant (P<0.01) effects were noted: cardiac index increased from a mean±1 S.D. of 1.8±0.3 to 2.6±0.3 liters per minute per square meter; peak rate of left ventricular pressure rise rose from 849±233 to 1206±456 mm Hg per second; left ventricular end-diastolic pressure fell from 25±9 to 14±7 mm Hg; pulmonary-capillary pressure fell from 28±8 to 15±4 mm Hg; and right atrial pressure fell from 12±6 to 7±5 mm Hg. Mean heart rate was unchanged, and aortic mean pressure declined slightly (86±10 to 80±7 mm Hg, P<0.025). No toxicity was observed. Amrinone, whose mechanism of action has not yet been defined, warrants further study as a possible treatment for heart failure. (N Engl J Med 299:1373–1377, 1978)