Abstract
Purpose
The purpose of this study is to assess the impact of milrinone on mitral annular velocity in patients with congestive heart failure.
Method
We studied 27 patients with congestive heart failure. All patients underwent transthoracic echocardiography both before and after administration of milrinone. We measured the early transmitral velocity (E) and the mitral annular early diastolic velocity (Ea). The ratio of E to Ea (E/Ea) was calculated. After the baseline echocardiography, milrinone was administered as a continuous infusion at a rate of 0.25 μg/kg/min. Echocardiographic measurements were repeated 4 h after milrinone was begun.
Results
After administration of milrinone, Ea was significantly increased, while E/Ea was significantly decreased. The population of 27 patients was divided into 20 (74 %) with left ventricular ejection fraction (LVEF) <50 % and seven (26 %) with LVEF ≥50 %. Ea was significantly increased in both groups, while E/Ea was significantly decreased.
Conclusion
Even low-dose milrinone produced an improvement in left ventricular (LV) diastolic function, as evidenced by an increase in Ea, and falls in LV filling pressures, as determined by a decrease in E/Ea, in patients with congestive heart failure throughout a wide range of LV systolic function.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Maskin CS, Sinoway L, Chadwick B, et al. Sustained hemodynamic and clinical effects of a new cardiotonic agent, WIN 47203, in patients with severe congestive heart failure. Circulation. 1983;67:1065–70.
Baim DS, McDowell AV, Cherniles J, et al. Evaluation of a new bipyridine inotropic agent—milrinone—in patients with severe congestive heart failure. N Engl J Med. 1983;309:748–56.
Monrad ES, McKay RG, Baim DS, et al. Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone. Circulation. 1984;70:1030–7.
Monrad ES, Baim DS, Smith HS, et al. Milrinone, dobutamine, and nitroprusside: comparative effects on hemodynamics and myocardial energetics in patients with severe congestive heart failure. Circulation. 1986;73:III-168-74.
Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997;30:474–80.
Nagueh SF, Middleton KJ, Kopelen HA, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527–33.
Tashiro H, Suda K, Tananari Y, et al. Impact of transcatheter closure of atrial septal defects on cardiac function. J Med Ultrason. 2012;39:147–53.
Rivas-Gotz C, Manolios M, Thohan V, et al. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol. 2003;91:780–4.
Dokainish H, Zoghbi WA, Lakkis NM, et al. Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation. 2004;109:2432–9.
Hadano Y, Murata K, Liu J, et al. Can transthoracic Doppler echocardiography predict the discrepancy between left ventricular end-diastolic pressure and mean pulmonary capillary wedge pressure in patients with heart failure? Circ J. 2005;69:432–8.
Hadano Y, Murata K, Tanaka N, et al. Ratio of early transmitral velocity to lateral mitral annular early diastolic velocity has the best correlation with wedge pressure. Circ J. 2007;71:1274–8.
Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989;2:358–67.
Yamamoto K. The spell of ventricular systolic function. J Med Ultrason. 2012;39:1–2.
Hadano Y, Murata K, Yamamoto T, et al. Usefulness of mitral annular velocity in predicting exercise tolerance in patients with impaired left ventricular systolic function. Am J Cardiol. 2006;97:1025–8.
Kobayashi S, Susa T, Tanaka T, et al. Low-dose β-blocker in combination with milrinone safely improves cardiac function and eliminates pulsus alternans in patients with acute decompensated heart failure. Circ J. 2012;76:1646–53.
Lobato EB, Willert JL, Looke TD, et al. Effects of milrinone versus epinephrine on left ventricular relaxation after cardiopulmonary bypass following myocardial revascularization: assessment by color M-mode and tissue Doppler. J Cardiothorac Vasc Anesth. 2005;19:334–9.
Couture P, Denault AY, Pellerin M, et al. Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery. Can J Anesth. 2007;54:509–22.
Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988;12:426–40.
Maeder MT, Karapanagiotidis S, Dewar EM, et al. Accuracy of Doppler echocardiography to estimate key hemodynamic variables in subjects with normal left ventricular ejection fraction. J Card Fail. 2011;17:405–12.
Larsson R, Liedholm H, Andersson KE, et al. Pharmacokinetics and effects on blood pressure of a single oral dose of milrinone in healthy subjects and in patients with renal impairment. Eur J Clin Pharmacol. 1986;29:549–53.
Mehra MR, Ventura HO, Kapoor C, et al. Safety and clinical utility of long-term intravenous milrinone in advanced heart failure. Am J Cardiol. 1997;80:61–4.
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Hadano, Y., Ogawa, H., Wakeyama, T. et al. Impact of milrinone on mitral annular velocity in patients with congestive heart failure. J Med Ultrasonics 40, 111–118 (2013). https://doi.org/10.1007/s10396-012-0405-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10396-012-0405-4