Low-Dose β-Blocker in Combination With Milrinone Safely Improves Cardiac Function and Eliminates Pulsus Alternans in Patients With Acute Decompensated Heart Failure

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Author(s)

    • KOBAYASHI Shigeki
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • SUSA Takehisa
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • TANAKA Takeo
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • MURAKAMI Wakako
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • FUKUTA Seiko
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • OKUDA Shinichi
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • DOI Masahiro
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • WADA Yasuaki
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • NAO Tomoko
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • YAMADA Jutaro
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • OKAMURA Takayuki
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • YANO Masafumi
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
    • MATSUZAKI Masunori
    • Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine

Abstract

<b><i>Background:</i></b> The purpose of this study was to determine whether a low-dose β-blocker, in combination with milrinone, improves cardiac function in acute decompensated heart failure (ADHF) with tachycardia. <b><i>Methods and Results:</i></b> Twenty ADHF patients (New York Heart Association classification III, n=1, and IV, n=19; heart rate [HR], 107±12beats/min; left ventricular ejection fraction, 24±7%; cardiac index [CI], 2.2±0.6L·min<sup>-1</sup>·m<sup>-2</sup>; pulmonary capillary wedge pressure [PCWP], 26±8mmHg) were enrolled in this study. The patients first underwent conventional therapy with milrinone, vasodilators and diuretics; landiolol (1.5-6.0μg·kg<sup>-1</sup>·min<sup>-1</sup>; i.v.), which is an ultra-short-acting β<sub>1</sub>-selective blocker, was then added to the treatment regimen to study its effect on hemodynamics. Low-dose landiolol (1.5μg·kg<sup>-1</sup>·min<sup>-1</sup>) significantly reduced HR by 11% without changing blood pressure (BP) and CI, whereas higher doses (≥3.0μg·kg<sup>-1</sup>·min<sup>-1</sup>) tended to decrease BP and CI while increasing PCWP and systemic vascular resistance. After treatment with landiolol (1.5μg·kg<sup>-1</sup>·min<sup>-1</sup>), hemodynamic parameters such as PCWP, stroke volume index, SvO<sub>2</sub>, rate pressure product, filling time/RR, E/e', and Tei index were significantly improved. <b><i>Conclusions:</i></b> A low-dose β-blocker in combination with milrinone improved cardiac function in ADHF patients with tachycardia; therefore, it may be considered as an adjunct therapy for use when standard therapy with milrinone is not effective at slowing HR.  (<i>Circ J</i> 2012; <b>76:</b> 1646–1653)<br>

Journal

  • Circulation Journal

    Circulation Journal 76(7), 1646-1653, 2012-06-25

    The Japanese Circulation Society

References:  32

Cited by:  4

Codes

  • NII Article ID (NAID)
    10030503344
  • NII NACSIS-CAT ID (NCID)
    AA11591968
  • Text Lang
    ENG
  • Article Type
    Journal Article
  • ISSN
    13469843
  • Data Source
    CJP  CJPref  J-STAGE 
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