Abstract
IntroductionInotropes are associated with adverse outcomes in heart failure (HF), raising concern they may accelerate myocardial injury. Whether biomarkers of myocardial necrosis, inflammation and apoptosis change in response to acute milrinone administration is not well established.MethodsTen patients with severe HF and reduced cardiac output who were to receive milrinone were studied. Blood samples were taken just before initiation of milrinone and after 24 hours of infusion. Dosing was at the discretion of the patient's attending physician (range 0.25–0.5 mcg/kg/min). Plasma measurements of troponin, myoglobin, N-terminal-pro-BNP, interleukin-6, tumor necrosis factor-α, soluble Fas, and soluble Fas-ligand were performed at both time points.ResultsTroponin was elevated at baseline in all patients (mean 0.1259 ± 0.17 ng/ml), but there was no significant change after 24 hours of milrinone (mean 0.1345 ± 0.16 ng/ml, p = 0.44). There were significant improvements in interleukin-6, tumor necrosis factor-α, soluble Fas, and soluble Fas-ligand (all p < 0.05) indicative of reduced inflammatory and apoptotic signaling compared to baseline.ConclusionIn conclusion, among patients with severe HF and low cardiac output, ongoing myocardial injury is common, and initiation of milrinone did not result in exacerbation of myocardial injury but instead was associated with salutary effects on other biomarkers.
Highlights
Inotropes are associated with adverse outcomes in heart failure (HF), raising concern they may accelerate myocardial injury
Certain other biomarkers are known to be indicators of inflammation and apoptosis, two processes which accumulating data suggest are important in the pathophysiology of HF
As a result the soluble Fas (sFas):soluble Fas-Ligand (sFas-L) ratio increased by 45% (p = 0.0016), consistent with reduced apoptotic signaling
Summary
Inotropes are associated with adverse outcomes in heart failure (HF), raising concern they may accelerate myocardial injury. Intravenous inotropic agents (inotropes) such as dobutamine and milrinone can produce improvements in cardiac output and patient's symptoms via increased contractility and heart rate. These type of agents have been associated increased arrhythmia risk and other adverse outcomes in heart failure (HF) [1,2,3]. Certain other biomarkers are known to be indicators of inflammation and apoptosis, two processes which accumulating data suggest are important in the pathophysiology of HF
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