Key result
Intravenous milrinone and dobutamine similarly increased cardiac index to 2.5 and 2.8 L/min/m2 (P<0.001 vs baseline), but milrinone did not increase myocardial oxygen consumption.
Why the study?
The systemic hemodynamic, coronary blood flow, and myocardial metabolic effects of intravenous milrinone compared to dobutamine in severe congestive heart failure were not fully characterized.
Does intravenous milrinone improve systemic hemodynamics and myocardial metabolism compared to dobutamine in patients with severe congestive heart failure?
Does intravenous milrinone improve systemic hemodynamics and myocardial metabolism compared to dobutamine in patients with severe congestive heart failure?
Intravenous milrinone improves cardiac index similarly to dobutamine but without increasing myocardial oxygen consumption, owing to its substantial vasodilating properties.
The effects of dobutamine and intravenous milrinone on systemic hemodynamics, coronary blood flow and myocardial metabolism were studied in 11 patients with severe congestive heart failure. Although milrinone and dobutamine similarly increased cardiac index from 1.9 +/- 0.4 to 2.5 +/- 0.4 liters/min per m2 (p less than 0.001) and from 1.9 +/- 0.4 to 2.8 +/- 0.8 liters/min per m2 (p less than 0.001), respectively, milrinone decreased left ventricular end-diastolic pressure to a greater extent than dobutamine, that is, from 26 +/- 6 to 12 +/- 8 mm Hg (p less than 0.001) versus 26 +/- 8 to 20 +/- 8 mm Hg (p less than 0.001). In contrast to dobutamine, milrinone significantly reduced mean systemic arterial and right atrial pressures. Dobutamine increased the first derivative of left ventricular pressure (dP/dt) from 1,013 +/- 309 to 1,360 +/- 538 mm Hg/s (p less than 0.01) but milrinone did not. Similarly, blood flow and myocardial oxygen consumption were increased by dobutamine from 152 +/- 87 to 187 +/- 118 ml/min (p less than 0.05) and from 17.7 +/- 10.9 to 21.5 +/- 14.9 ml O2/min (p less than 0.05), respectively, but were unchanged by milrinone. Both drugs significantly decreased coronary vascular resistance and myocardial oxygen extraction but did not change myocardial lactate extraction. Thus, dobutamine and milrinone produce similar improvement in cardiac index. However, dobutamine increases myocardial oxygen consumption, whereas milrinone does not. This difference can probably be explained by the substantial vasodilating properties of milrinone.
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Grose et al. (1986) studied Severe congestive heart failure (n=11). Intravenous milrinone vs. Dobutamine was evaluated on Cardiac index (p=<0.001). Intravenous milrinone and dobutamine similarly increased cardiac index to 2.5 and 2.8 L/min/m2 (P<0.001 vs baseline), but milrinone did not increase myocardial oxygen consumption.
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