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. 1984 Jul;52(1):38–48. doi: 10.1136/hrt.52.1.38

Comparison of the effects of amrinone and sodium nitroprusside on haemodynamics, contractility, and myocardial metabolism in patients with cardiac failure due to coronary artery disease and dilated cardiomyopathy.

P T Wilmshurst, D S Thompson, S M Juul, B S Jenkins, D J Coltart, M M Webb-Peploe
PMCID: PMC481582  PMID: 6743422

Abstract

The effects of intravenous amrinone and sodium nitroprusside on haemodynamic indices, left ventricular contractility, and myocardial metabolism were compared in patients with cardiac failure. All patients received one dose of each drug and some received serial doses. Eight patients had dilated cardiomyopathy and six coronary artery disease, but the responses to the two drugs were independent of the aetiology of cardiac failure. Both drugs lowered left ventricular end diastolic pressure and aortocoronary sinus oxygen difference and increased cardiac index and left ventricular efficiency; these effects were dose related. Although the effects of the drugs on peripheral blood substrate concentrations were different, those on myocardial substrate metabolism were identical. Pressure derived indices of contractility in each group of patients were unaltered by either drug. After amrinone administration increases in cardiac index were related to plasma amrinone concentration, but alterations in contractility were not. In four individual patients increases in contractility were associated with alterations in plasma metabolite concentrations, which suggested that catecholamine release had occurred. For the groups of patients as a whole, however, amrinone had effects which did not differ significantly from those of the pure vasodilator, nitroprusside. There was no evidence that amrinone had a direct positive inotropic effect since no dose related changes in indices of contractile function could be established.

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Selected References

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  1. Armstrong P. W., Gold H. K., Daggett W. M., Austen W. G., Sanders C. A. Hemodynamic evaluation of glucagon in symptomatic heart disease. Circulation. 1971 Jul;44(1):67–73. doi: 10.1161/01.cir.44.1.67. [DOI] [PubMed] [Google Scholar]
  2. Baim D. S., McDowell A. V., Cherniles J., Monrad E. S., Parker J. A., Edelson J., Braunwald E., Grossman W. Evaluation of a new bipyridine inotropic agent--milrinone--in patients with severe congestive heart failure. N Engl J Med. 1983 Sep 29;309(13):748–756. doi: 10.1056/NEJM198309293091302. [DOI] [PubMed] [Google Scholar]
  3. Bayliss J., Norell M., Canepa-Anson R., Reuben S. R., Poole-Wilson P. A., Sutton G. C. Acute haemodynamic comparison of amrinone and pirbuterol in chronic heart failure. Additional effects of isosorbide dinitrate. Br Heart J. 1983 Mar;49(3):214–221. doi: 10.1136/hrt.49.3.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Benmansour M., Rainfray M., Paillard F., Ardaillou R. Metabolic clearance rate of immunoreactive vasopressin in man. Eur J Clin Invest. 1982 Dec;12(6):475–480. doi: 10.1111/j.1365-2362.1982.tb02228.x. [DOI] [PubMed] [Google Scholar]
  5. Benotti J. R., Grossman W., Braunwald E., Davolos D. D., Alousi A. A. Hemodynamic assessment of amrinone. A new inotropic agent. N Engl J Med. 1978 Dec 21;299(25):1373–1377. doi: 10.1056/NEJM197812212992501. [DOI] [PubMed] [Google Scholar]
  6. Bowman W. C., Nott M. W. Actions of sympathomimetic amines and their antagonists on skeletal muscle. Pharmacol Rev. 1969 Mar;21(1):27–72. [PubMed] [Google Scholar]
  7. Brooksby I. A., Swanton R. H., Jenkins B. S., Webb-Peploe M. M. Long sheath technique for introduction of catheter tip manometer or endomyocardial bioptome into left or right heart. Br Heart J. 1974 Sep;36(9):908–912. doi: 10.1136/hrt.36.9.908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cárdenas M., Vidaurri A. Estudio de los efectos hemodinámicos de diferentes dosis de un nuevo inotrópico: la amrinona. Arch Inst Cardiol Mex. 1979 Sep-Oct;49(5):961–968. [PubMed] [Google Scholar]
  9. Edelson J., LeJemtel T. H., Alousi A. A., Biddlecome C. E., Maskin C. S., Sonnenblick E. H. Relationship between amrinone plasma concentration and cardiac index. Clin Pharmacol Ther. 1981 Jun;29(6):723–728. doi: 10.1038/clpt.1981.102. [DOI] [PubMed] [Google Scholar]
  10. Endoh M., Yamashita S., Taira N. Positive inotropic effect of amrinone in relation to cyclic nucleotide metabolism in the canine ventricular muscle. J Pharmacol Exp Ther. 1982 Jun;221(3):775–783. [PubMed] [Google Scholar]
  11. Gaide M. S., Fitterman W. S., Wiggins J. R., Myerburg R. J., Cameron J. S., Bassett A. L. Amrinone relaxes potassium-induced contracture of failing right ventricular muscle of cats. J Cardiovasc Pharmacol. 1983 Mar-Apr;5(2):335–340. doi: 10.1097/00005344-198303000-00028. [DOI] [PubMed] [Google Scholar]
  12. Goldstein R. E., Skelton C. L., Levey G. S., Glancy D. L., Beiser G. D., Epstein S. E. Effects of chronic heart failure on the capacity of glucagon to enhance contractility and adenyl cyclase activity of human papillary muscles. Circulation. 1971 Oct;44(4):638–648. doi: 10.1161/01.cir.44.4.638. [DOI] [PubMed] [Google Scholar]
  13. Hashimoto H., Okumura K., Niizoe K., Ogawa K. Effects of dibutyryl cyclic AMP on patients with severe heart failure. Jpn Heart J. 1982 Nov;23(6):1021–1027. doi: 10.1536/ihj.23.1021. [DOI] [PubMed] [Google Scholar]
  14. Honerjäger P., Schäfer-Korting M., Reiter M. Involvement of cyclic AMP in the direct inotropic action of amrinone. Biochemical and functional evidence. Naunyn Schmiedebergs Arch Pharmacol. 1981 Dec;318(2):112–120. doi: 10.1007/BF00508835. [DOI] [PubMed] [Google Scholar]
  15. Keilin D., Hartree E. F. Properties of glucose oxidase (notatin): Addendum. Sedimentation and diffusion of glucose oxidase (notatin). Biochem J. 1948;42(2):221–229. [PMC free article] [PubMed] [Google Scholar]
  16. Kinney E. L., Carlin B., Ballard J. O., Burks J. M., Hallahan W. F., Zelis R. Clinical experience with amrinone in patients with advanced congestive heart failure. J Clin Pharmacol. 1982 Oct;22(10):433–440. doi: 10.1002/j.1552-4604.1982.tb02632.x. [DOI] [PubMed] [Google Scholar]
  17. Kolettis M., Jenkins B. S., Webb-Peploe M. M. Assessment of left ventricular function by indices derived from aortic flow velocity. Br Heart J. 1976 Jan;38(1):18–31. doi: 10.1136/hrt.38.1.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kullberg M. P., Dorrbecker B., Lennon J., Rowe E., Edelson J. High-performance liquid chromatographic analysis of amrinone and its N-acetyl derivative in plasma. Pharmacokinetics of amrinone in the dog. J Chromatogr. 1980 Jan 4;187(1):264–270. doi: 10.1016/s0021-9673(00)87899-1. [DOI] [PubMed] [Google Scholar]
  19. LeJemtel T. H., Keung E. C., Schwartz W. J., Maskin C. S., Greenberg M. A., Davis R. S., Forman R., Ribner H. S., Sonnenblick E. H. Hemodynamic effects of intravenous and oral amrinone in patients with severe heart failure: relationship between intravenous and oral administration. Trans Assoc Am Physicians. 1979;92:325–333. [PubMed] [Google Scholar]
  20. LeJemtel T. H., Keung E., Sonnenblick E. H., Ribner H. S., Matsumoto M., Davis R., Schwartz W., Alousi A. A., Davolos D. Amrinone: a new non-glycosidic, non-adrenergic cardiotonic agent effective in the treatment of intractable myocardial failure in man. Circulation. 1979 Jun;59(6):1098–1104. doi: 10.1161/01.cir.59.6.1098. [DOI] [PubMed] [Google Scholar]
  21. Leier C. V., Dalpiaz K., Huss P., Hermiller J. B., Magorien R. D., Bashore T. M., Unverferth D. V. Amrinone therapy for congestive heart failure in outpatients with idiopathic dilated cardiomyopathy. Am J Cardiol. 1983 Aug;52(3):304–308. doi: 10.1016/0002-9149(83)90128-5. [DOI] [PubMed] [Google Scholar]
  22. Marcus M. L., Skelton C. L., Grauer L. E., Epstein S. E. Effects of theophylline on myocardial mechanics. Am J Physiol. 1972 Jun;222(6):1361–1365. doi: 10.1152/ajplegacy.1972.222.6.1361. [DOI] [PubMed] [Google Scholar]
  23. Matsui S., Murakami E., Takekoshi N., Emoto J., Matoba M. Hemodynamic effects of dibutyryl cyclic AMP in congestive heart failure. Am J Cardiol. 1983 May 1;51(8):1364–1368. doi: 10.1016/0002-9149(83)90313-2. [DOI] [PubMed] [Google Scholar]
  24. Onuaguluchi G., Tanz R. D. Cardiac effects of amrinone on rabbit papillary muscle and guinea pig Langendorff heart preparations. J Cardiovasc Pharmacol. 1981 Nov-Dec;3(6):1342–1355. doi: 10.1097/00005344-198111000-00022. [DOI] [PubMed] [Google Scholar]
  25. Satoh K. [Effect of dibutyryl cyclic AMP on hemodynamics and metabolism of carbohydrates and lipid after extracorporeal circulation in cardiac surgical patients (author's transl)]. Nihon Kyobu Geka Gakkai Zasshi. 1980 Mar;28(3):425–437. [PubMed] [Google Scholar]
  26. Siskind S. J., Sonnenblick E. H., Forman R., Scheuer J., LeJemtel T. H. Acute substantial benefit of inotropic therapy with amrinone on exercise hemodynamics and metabolism in severe congestive heart failure. Circulation. 1981 Nov;64(5):966–973. doi: 10.1161/01.cir.64.5.966. [DOI] [PubMed] [Google Scholar]
  27. Skelton C. L., Levey G. S., Epstein S. E. Positive inotropic effects of dibutyryl cyclic adenosine 3',5'-monophosphate. Circ Res. 1970 Jan;26(1):35–43. doi: 10.1161/01.res.26.1.35. [DOI] [PubMed] [Google Scholar]
  28. Stein P. D., Sabbah H. N. Rate of change of ventricular power: an indicator of ventricular performance during ejection. Am Heart J. 1976 Feb;91(2):219–227. doi: 10.1016/s0002-8703(76)80577-7. [DOI] [PubMed] [Google Scholar]
  29. Thompson D. S., Juul S. M., Wilmshurst P., Naqvi N., Coltart D. J., Jenkins B. S., Webb-Peploe M. M. Effects of sodium nitroprusside upon cardiac work, efficiency, and substrate extraction in severe left ventricular failure. Br Heart J. 1981 Oct;46(4):394–400. doi: 10.1136/hrt.46.4.394. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Thompson D. S., Naqvi N., Juul S. M., Coltart D. J., Jenkins B. S., Webb-Peploe M. M. Haemodynamic and metabolic effects of atenolol in patients with angina pectoris. Br Heart J. 1980 Jun;43(6):668–679. doi: 10.1136/hrt.43.6.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Thompson D. S., Naqvi N., Juul S. M., Swanton R. H., Wilmshurst P., Coltart D. J., Jenkins B. S., Webb-Peploe M. M. Cardiac work and myocardial substrate extraction in congestive cardiomyopathy. Br Heart J. 1982 Feb;47(2):130–136. doi: 10.1136/hrt.47.2.130. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Timmis A., Daly K., Jewitt D. E. Haemodynamic effects of intravenous amrinone in patients with impaired left ventricular function. Br Heart J. 1983 Jul;50(1):106–108. doi: 10.1136/hrt.50.1.106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Vander Ark C. R., Reynolds E. W., Jr Clinical evaluation of glucagon by continuous infusion in the treatment of low cardiac output states. Am Heart J. 1970 Apr;79(4):481–487. doi: 10.1016/0002-8703(70)90253-x. [DOI] [PubMed] [Google Scholar]
  34. Veragut U. P., Krayenbühl H. P. Estimation and quantification of myocardial contractility in the closed-chest dog. Cardiologia. 1965;47(2):96–112. doi: 10.1159/000168382. [DOI] [PubMed] [Google Scholar]
  35. Vestal R. E., Eiriksson C. E., Jr, Musser B., Ozaki L. K., Halter J. B. Effect of intravenous aminophylline on plasma levels of catecholamines and related cardiovascular and metabolic responses in man. Circulation. 1983 Jan;67(1):162–171. doi: 10.1161/01.cir.67.1.162. [DOI] [PubMed] [Google Scholar]
  36. Wilmshurst P. T., Al-Hasani S. F., Semple M. J., Hamblin A. S., Kioy P. G., Lucas G. F., Savidge G. F., Webb-Peploe M. M. The effects of amrinone on platelet count, survival and function in patients with congestive cardiac failure. Br J Clin Pharmacol. 1984 Mar;17(3):317–324. doi: 10.1111/j.1365-2125.1984.tb02347.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Wilmshurst P. T., Thompson D. S., Jenkins B. S., Coltart D. J., Webb-Peploe M. M. Haemodynamic effects of intravenous amrinone in patients with impaired left ventricular function. Br Heart J. 1983 Jan;49(1):77–82. doi: 10.1136/hrt.49.1.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Wilsmhurst P. T., Webb-Peploe M. M. Side effects of amrinone therapy. Br Heart J. 1983 May;49(5):447–451. doi: 10.1136/hrt.49.5.447. [DOI] [PMC free article] [PubMed] [Google Scholar]

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