6. Digitálicos
Digoxina y otros
Inhibidores de la Fosfodiesterasa
Milrinona, Enoximone
Sensibilizadores del Calcio
Levosimendan, Pimobendan
Agonistas Beta
Dopamina, Dobutamina
Hormona del Crecimiento
14. Mehra MR, et al. Safety and clinical utility of long-term intravenous
milrinone in advanced heart failure.
–Am J Cardiol 1997
Marius-Nunez AL, et al. Intermittent inotropic therapy in an
outpatient setting: A cost-effective therapeutic modality in
patients with refractory heart failure.
–Am Heart J 1996
Milfred-LaForest SK, et al. Tolerability of extended duration
intravenous milrinone in patients hospitalized for advanced heart
failure and the usefulness of uptitration of oral angiotensin-
converting enzyme inhibitors.
–Am J Cardiol 1999
15. OPTIME-CHF
Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure
n=949, FE~23%
milrinona vs placebo
60 d
48-72 h
–Cuffe MS, JAMA 2002
16. OPTIME-CHF
Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of
Chronic Heart Failure
hipotensión sintomática
arritmias supraventriculares
mortalidad intrahospitalaria (3.8% vs 2.3%)
mortalidad a 60 días (10.3% vs 8.9%)
–Cuffe MS, JAMA 2002
17. Análisis “post hoc”…
Más días de hospitalización
Mayor mortalidad
–Felker GM, J Am Coll Cardiol 2003
20. PROMISE
Prospective Randomized Milrinone Survival Evaluation
mortalidad x cualquier causa (30% vs 24%)
mortalidad x causa cardiovascular (34%)
nº de hospitalizaciones
efectos adversos
24. Combined oral positive inotropic and beta-blocker
therapy for treatment of refractory class IV heart failure
n=30, IC CF IV
Seguimiento x 21m
Régimen bien tolerado (80%)
enoximone
Mejor FE (28% vs 18%)
Mejor CF
Descontinuación de enoximone (50%)
–Shakar SF et al, J Am Coll Cardiol 1998
34. IC, PCWP, síntomas
Slawsky MT, et al. Circulation 2000
Efectos dosis dependientes (0,05-0,6μg/kg/min)
Nieminen MS, et. J Am Coll Cardiol 2000
Mejores índices hemodinámicos
Follath F, et al. Lancet 2002, the LIDO study
Peor en mejoría de la disnea
Mebazaa A, et al. JAMA 2007, the SURVIVE Randomized Trial