Effect of Milrinone Infusion on Pulmonary Vasculature and Stroke Work Indices: A Single-Center Retrospective Analysis in 69 Patients Awaiting Cardiac Transplantation.

Abstract

Although milrinone infusion is reported to benefit left ventricular function in chronic left heart failure, few insights exist regarding its effects on pulmonary circulation and right ventricular function. We retrospectively reviewed right heart catheterization data at baseline and during continuous infusion of milrinone in 69 patients with advanced heart failure and analyzed the effects on ventricular stroke work indices, pulmonary vascular resistance and pulmonary arterial compliance. Compared to baseline, milrinone infusion after a mean 58±61days improved mean left ventricular stroke work index (1540±656 vs. 2079±919mmHg·mL/m2, p=0.0007) to a much greater extent than right ventricular stroke work index (616±346 vs. 654±332, p=0.053); however, patients with below median stroke work indices experienced a significant improvement in both left and right ventricular stroke work performance. Overall, milrinone reduced left and right ventricular filling pressures and pulmonary and systemic vascular resistance by approximately 20%. Despite an increase in pulmonary artery capacitance (2.3±1.6 to 3.0±2.0, p=0.013) and a reduction in pulmonary vascular resistance (3.8±2.3 to 3.0±1.7 Wood units), milrinone did not reduce the transpulmonary gradient (13±7 vs. 12±6mmHg, p=0.252), the pulmonary artery pulse pressure (25±10 vs. 24±10, p=0.64) or the pulmonary artery diastolic to pulmonary capillary wedge gradient (2.0±6.5 vs. 2.4±6.0, p=0.353). Milrinone improved left ventricular stroke work indices to a greater extent than right ventricular stroke work indices and had beneficial effects on right ventricular net input impedance, predominantly via augmentation of left ventricular stroke volume and passive unloading of the pulmonary circuit. Patients who had the worst biventricular performance benefited the most from chronic milrinone infusion.