Low-dose β-blocker in combination with milrinone safely improves cardiac function and eliminates pulsus alternans in patients with acute decompensated heart failure

Circulation Journal : Official Journal of the Japanese Circulation Society
Shigeki KobayashiMasunori Matsuzaki

Abstract

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. Twenty ADHF patients (New York Heart Association classification III, n=1, and IV, n=19; heart rate [HR], 107±12 beats/min; left ventricular ejection fraction, 24±7%; cardiac index [CI], 2.2±0.6 L·min(-1)·m(-2); pulmonary capillary wedge pressure [PCWP], 26±8 mmHg) were enrolled in this study. The patients first underwent conventional therapy with milrinone, vasodilators and diuretics; landiolol (1.5-6.0 µg·kg(-1)·min(-1); i.v.), which is an ultra-short-acting β(1)-selective blocker, was then added to the treatment regimen to study its effect on hemodynamics. Low-dose landiolol (1.5 µg·kg(-1)·min(-1)) significantly reduced HR by 11% without changing blood pressure (BP) and CI, whereas higher doses (≥3.0 µg·kg(-1)·min(-1)) tended to decrease BP and CI while increasing PCWP and systemic vascular resistance. After treatment with landiolol (1.5 µg·kg(-1)·min(-1)), hemodynamic parameters such as PCWP, stroke volume index, SvO(2), rate pressure product, filling time/RR, E/e', and Tei index were significantly improved. A low-dose β-blocker in comb...Continue Reading

Citations

May 9, 2013·Journal of Anesthesia·Zen'ichiro WajimaTetsuo Inoue
Apr 1, 2013·Journal of Medical Ultrasonics·Yasuyuki HadanoMasunori Matsuzaki
Oct 16, 2012·Heart, Lung & Circulation·Nobuhiko HarukiYutaka Otsuji
Jun 18, 2016·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Shiro IshiharaAlexandre Mebazaa
Jul 17, 2015·Circulation. Heart Failure·Taimoor HashimDeepak Acharya
Apr 12, 2016·Frontiers in Pharmacology·Shih-Min Wang
Aug 21, 2012·American Journal of Physiology. Heart and Circulatory Physiology·Stela M Florea, Lothar A Blatter
Sep 13, 2013·Pacing and Clinical Electrophysiology : PACE·Takeshi KashimuraTohru Minamino
Apr 24, 2017·JACC. Basic to Translational Science·Lance D Wilson, Kenneth R Laurita

Related Concepts

Landiolol
Acute Disease
Adrenergic beta-Antagonists
Cardiac Arrhythmia
Cardiotonic Agents
Polychemotherapy
Myocardial Failure
Pulse Rate
Hemodynamics
Morpholines

Related Feeds

Antiarrhythmic Agents: Mechanisms of Action

Understanding the mechanism of action of antiarrhythmic agents is essential in developing new medications as treatment of cardiac arrhythmias is currently limited by the reduced availability of safe and effective drugs. Discover the latest research on Antiarrhythmic Agents: Mechanism of Action here.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.