Key result
Baseline baroreflex sensitivity was significantly higher in milrinone responders than nonresponders (7.3 vs 3.2 ms/mmHg), predicting response with 94% sensitivity and 93% specificity at a 5 ms/mmHg cut-off.
Why the study?
Does baseline baroreflex sensitivity predict response to intravenous milrinone in patients with acute wet and cold heart failure?
Observational (n=24)
No
Does baseline baroreflex sensitivity predict response to intravenous milrinone in patients with acute wet and cold heart failure?
Baseline baroreflex sensitivity measured by the spontaneous sequence method may be a useful noninvasive predictor of response to milrinone in patients with acute "wet and cold" heart failure and preserved blood pressure.
May support noninvasive baroreflex testing to guide milrinone in acute wet-cold HF; hypothesis-generating and requires prospective validation.
The phosphodiesterase III inhibitor milrinone (MIL) is considered to be effective for "wet and cold" heart failure. In some cases, however, the inotropic effects of milrinone are insufficient. A previous study suggested that baroreflex sensitivity (BRS) predicts the cases in which MIL increases left ventricular dp/dt. The aim of this study was to determine whether BRS measured using the spontaneous sequence method predicts the MIL responders. Twenty-four patients with "wet and cold" heart failure whose systolic blood pressure > 100 mmHg were enrolled. At 2 hours MIL improved dys-pnea, general fatigue, urine volume, and tricuspid regurgitant pressure gradient in 13 patients (responders; R group), whereas it failed to improve in 11 patients (nonresponders; NR group). BRS in the R group was significantly higher than that in the NR group prior to the MIL infusion. At 2 hours after the MIL infusion, BRS was further increased in the R group, but did not increase in the NR group. The sensitivity and specificity of BRS at a cut-off level of 5 ms/mmHg for the prediction of R group were 0.94 and 0.93, respectively. BRS might be useful for identifying potential responders to milrinone in patients with blood pressure-preserved "wet and cold" heart failure.
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Kishi et al. (2010) conducted an observational in Acute heart failure ('wet and cold' profile) (n=24). Baroreflex sensitivity (BRS) vs. Nonresponders to milrinone was evaluated on Baseline baroreflex sensitivity (BRS) in responders vs nonresponders (Sensitivity 0.94, Specificity 0.93 (at 5 ms/mmHg cut-off), p=<0.05). Baseline baroreflex sensitivity was significantly higher in milrinone responders than nonresponders (7.3 vs 3.2 ms/mmHg), predicting response with 94% sensitivity and 93% specificity at a 5 ms/mmHg cut-off.
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