Abstract
Background: The purpose of this study was to determine whether a low-dose β-blocker, in combination with milrinone, improves cardiac function in acute decompensated heart failure (ADHF) with tachycardia. Methods and Results: Twenty ADHF patients (New York Heart Association classification III, n=1, and IV, n=19; heart rate [HR], 107±12beats/min; left ventricular ejection fraction, 24±7%; cardiac index [CI], 2.2±0.6L·min-1·m-2; pulmonary capillary wedge pressure [PCWP], 26±8mmHg) were enrolled in this study. The patients first underwent conventional therapy with milrinone, vasodilators and diuretics; landiolol (1.5-6.0μg·kg-1·min-1; i.v.), which is an ultra-short-acting β1-selective blocker, was then added to the treatment regimen to study its effect on hemodynamics. Low-dose landiolol (1.5μg·kg-1·min-1) significantly reduced HR by 11% without changing blood pressure (BP) and CI, whereas higher doses (≥3.0μg·kg-1·min-1) tended to decrease BP and CI while increasing PCWP and systemic vascular resistance. After treatment with landiolol (1.5μg·kg-1·min-1), hemodynamic parameters such as PCWP, stroke volume index, SvO2, rate pressure product, filling time/RR, E/e', and Tei index were significantly improved. Conclusions: A low-dose β-blocker in combination with milrinone improved cardiac function in ADHF patients with tachycardia; therefore, it may be considered as an adjunct therapy for use when standard therapy with milrinone is not effective at slowing HR. (Circ J 2012; 76: 1646–1653)
