The phosphodiesterase III inhibitor milrinone (MIL) is considered to be effective for "wet and cold" heart failure. In some cases, however, the inotropic effects of milrinone are insuffcient. A previous study suggested that barorefex sensitivity (BRS) predicts the cases in which MIL increases left ventricular dp/dt. The aim of this study was to determine whether BRS measured using the spontaneous sequence method predicts the MIL responders. Twenty-four patients with "wet and cold" heart failure whose systolic blood pressure > 100 mmHg were enrolled. At 2 hours MIL improved dyspnea, general fatigue, urine volume, and tricuspid regurgitant pressure gradient in 13 patients (responders; R group), whereas it failed to improve in 11 patients (nonresponders; NR group). BRS in the R group was significantly higher than that in the NR group prior to the MIL infusion. At 2 hours after the MIL infusion, BRS was further increased in the R group, but did not increase in the NR group. The sensitivity and specificity of BRS at a cut-off level of 5 ms/mmHg for the prediction of R group were 0.94 and 0.93, respectively. BRS might be useful for identifying potential responders to milrinone in patients with blood pressure-preserved "wet and cold" heart failure.
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