[Hemodynamics with dobutamine and milrinone in patients with severe heart failure in an intra-individual comparison]

Hemodynamics during 24-h dobutamine (dob) and subsequent 24-h milrinone (mil) infusion were studied in 20 patients (pts) with severe heart failure (NYHA III: 4 pts, NYHA IV: 16 pts). Three of 20 patients showed a heart-rate increase to 140 bpm and more during dob; five patients were non-responders to dob. Heart rate rose (p less than or equal to 0.001) during dob from 88.8 to 105.6 bpm (+1 hr) and then decreased to 93.0 bpm after 24 h; stroke volume index increased (p less than or equal to 0.001) from 19.3 to 28.9 ml.m-2 (+49.6%) after 1 h and then decreased to 25.2 ml.m-2 after 12 h as did heart rate. During mil heart rate did not change; stroke volume index increased from 18.8 to 31.2 (+66.0%, p less than or equal to 0.001) after 1 h and showed no development of tolerance during the rest of the infusion period. PCWP decreased (p less than or equal to 0.001) during mil from 26.5 to 16.2 mm Hg after 30 min, tending upward again to 20.1 mm Hg after 24 h; during dob the decrease (p less than or equal to 0.01) of PCWP from 27.8 to 19.0 mm Hg after 6 h was delayed, also tending upward during the rest of the infusion period to 22.7 mm Hg after 24 h. There was no sustained decrease of PVR during dob, but after the start of mil infusion PVR decreased (p less than or equal to 0.001) from 312.7 to 172.1 dynes/s/cm-5 (+15 min), remaining on this level during the rest of mil infusion.(ABSTRACT TRUNCATED AT 250 WORDS)