Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol

Brian D. Lowes, Tatiana Tsvetkova, Eric J. Eichhorn, Edward M. Gilbert, Michael R. Bristow

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objective: To compare the efficacy of milrinone and dobutamine in patients chronically treated with carvedilol. Background: Milrinone and dobutamine are used to manage decompensated heart failure, but their efficacy in patients on beta-blocker therapy was unknown. Methods: Twenty patients with decompensated heart failure were prospectively enrolled. Inotropic responses to milrinone (12.5, 25 or 50 μg/kg bolus infusions) or dobutamine (5, 10, 15 or 20 μg/kg/min infusions) were evaluated by right-heart catheterization. Results: Milrinone increased cardiac index (2.0-2.6 l/min/m2, P=0.0001) without significantly altering heart rate (70-75 bpm, P=0.19). Milrinone decreased mean pulmonary artery pressure (36-29 mm Hg, P=0.0001), pulmonary capillary wedge pressure (24-18 mm Hg, P=0.0001) and mean arterial blood pressure (78-75 mm Hg, P=0.0002). Left ventricular stroke volume index increased in the milrinone group (31-35 ml/beat/m2, P=0.0001). Dobutamine produced an increase in cardiac index (2.4-3.3 l/min/m2, P=0.0001) only at doses that are not typically used to treat heart failure (15-20 μg/kg/min). At these doses, dobutamine increased heart rate (68-82 bpm, P=0.008), mean systemic pressure (90-117 mm Hg, P=0.0001) and mean pulmonary artery pressure (21-30 mm Hg, P=0.001). Dobutamine did not alter left ventricular stroke volume index or pulmonary capillary wedge pressure. Conclusions: Dobutamine and milrinone have different hemodynamic effects in patients treated chronically with carvedilol. These differences should be considered when selecting inotropic therapy for decompensated heart failure.

Original languageEnglish (US)
Pages (from-to)141-149
Number of pages9
JournalInternational Journal of Cardiology
Volume81
Issue number2-3
DOIs
StatePublished - Dec 1 2001

Fingerprint

Milrinone
Dobutamine
Heart Failure
Pulmonary Wedge Pressure
Pressure
Stroke Volume
Pulmonary Artery
Arterial Pressure
Heart Rate
Cardiac Catheterization
carvedilol
Hemodynamics
Therapeutics

Keywords

  • Beta blockade
  • Heart failure
  • Inotropic therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol. / Lowes, Brian D.; Tsvetkova, Tatiana; Eichhorn, Eric J.; Gilbert, Edward M.; Bristow, Michael R.

In: International Journal of Cardiology, Vol. 81, No. 2-3, 01.12.2001, p. 141-149.

Research output: Contribution to journalArticle

Lowes, Brian D. ; Tsvetkova, Tatiana ; Eichhorn, Eric J. ; Gilbert, Edward M. ; Bristow, Michael R. / Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol. In: International Journal of Cardiology. 2001 ; Vol. 81, No. 2-3. pp. 141-149.
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AU - Tsvetkova, Tatiana

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AU - Bristow, Michael R.

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KW - Inotropic therapy

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