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

Wilmshurst, P.T.; Thompson, D.S.; Juul, S.M.; Jenkins, B.S.; Coltart, D.J.; Webb-Peploe, M.M.

British Heart Journal 52(1): 38-48


ISSN/ISBN: 0007-0769
PMID: 6743422
Accession: 005013835

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The effects of i.v. amrinone and sodium nitroprusside on hemodynamic indices, left ventricular contractility and myocardial metabolism were compared in patients with cardiac failure. All patients received 1 dose of each drug and some received serial doses. Eight patients had dilated cardiomyopathy and 6 coronary artery disease, but the responses to the 2 drugs were independent of the etiology of cardiac failure. Both drugs lowered left ventricular end diastolic pressure and autocoronary sinus O2 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 of 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 4 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.