Effect of amrinone in acute severe cardiac failure

5-Amino-(3,4'-bipyridine)-6(1H)-one (amrinone, WIN-40680, Wincoram) is a potent positive inotropic agent with vasodilator properties. Its positive inotropic effects are unaffected by propranolol and by pre-treatment with reserpine. The effect of intravenous amrinone was studied in 15 patients with acute severe cardiac failure (NYHA class IV) who had failed to respond adequately to treatment with cardiac glycosides, diuretics, vasodilators and catecholamines. Catecholamine dosage was held constant during the period of the study. This is the first report of standardised combination therapy with catecholamines and amrinone. Initially, a mean cumulative dose of 1.6 +/- 0.3 mg/kg of amrinone was administered during the 1st h. This was followed by a long-term infusion of 5-15 micrograms/kg.min. Hemodynamic parameters were monitored by invasive techniques for a minimum of 48 h. At the time of maximal effect, the cardiac index increased from 1.54 +/- 0.35 to 2.8 +/- 0.61 l/min.m2 (p less than 0.001), and the pulmonary arterial capillary pressure decreased from 31 +/- 7.1 to 23 +/- 7.6 mmHg (p less than 0.01). Heart rate and systemic mean arterial blood pressure showed no significant changes during treatment. These results indicate that amrinone may be effective in patients with acute severe cardiac failure refractory to catecholamines.