The haemodynamic effects of amrinone in patients with mitral stenosis and pulmonary hypertension

Abstract

The aim of this study was to investigate the haemodynamic effects of amrinone in patients with pulmonary hypertension and impaired right ventricular function. Twelve patients with mitral stenosis (NYHA classification III and IV) took part in the study. The haemodynamic measurements were performed in the steady state under anaesthesia prior to surgery. The patients received a bolus injection of 1.5 mg kg-1 amrinone; haemodynamic measurements were taken at 3, 5, 10, 15, 20 and 30 min. Amrinone increased cardiac index by approximately 30%, heart rate rose from on average 76 to 82 beats per minute. Whereas pulmonary capillary pressure did not change significantly, mean pulmonary artery pressure fell clearly from 33 to 28 mmHg. A decrease in the elevated pulmonary vascular resistance of about 40% was calculated. The higher the initial value for resistance in the pulmonary circulatory system, the more marked was the reduction (r = 0.96). The study shows that amrinone induces a vasodilation in the pulmonary circulatory system. A reduction in ventricular afterload is of great significance particularly for the therapy of right heart insufficiency. Amrinone therefore appears to be a suitable substance with its observed vasodilating and its well known positive inotropic effects for the treatment of right heart failure in cases of pulmonary hypertension.

Study on the Effectiveness of Toborinone (OPC-18790) in the Treatment of Heart Failure in Patients Following Cardiac Surgery

“…The use of catecholamines is frequently associated with tachycardia or dysrhythmias, resulting in an imbalance in the myocardial oxygen supply/demand ratio [5]. Other phosphodiesterase inhibitors, such as amrinone [6] and milrinone [7], are also known to increase heart rate, and that is expected to result in increased myocardial oxygen consumption. In contrast, toborinone is known to have positive inotropic and vasodilating effects without increasing myocardial oxygen consumption [2].…”

Perioperative Management of Pulmonary Hypertension in Children with Critical Heart Disease

“…As with obstructed TAPVR, therapies that decrease PVR increase pulmonary blood flow and may precipitate pulmonary edema without improving CO. Atz et al [48] evaluated iNO in children with PHTN due to congenital mitral stenosis and demonstrated significant reductions in PVR and pulmonary artery pressures; however, cardiac output remained unchanged. Hess et al [49] evaluated the effects of amrinone in 12 adult patients with mitral stenosis and RV dysfunction. The combined inotropic and vasodilating properties of amrinone produced significant reductions in PVR and pulmonary arterial pressures, as well as significant increases in CO. Aortic stenosis and coarctation of the aorta cause PHTN.…”