Low-Dose β-Blocker in Combination With Milrinone Safely Improves Cardiac Function and Eliminates Pulsus Alternans in Patients With Acute Decompensated Heart Failure

Background: The purpose of this study was to determine whether a low-dose beta-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 [HA], 107 +/- 12 beats/min; left ventricular ejection fraction, 24 +/- 7%; cardiac index [Cl], 2.2 +/- 0.6 L.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 (1.5-6.0 mu g.kg(-1).min(-1); i.v.), which is an ultra-short-acting beta(1)-selective blocker, was then added to the treatment regimen to study its effect on hemodynamics. Low-dose landiolol (1.5 mu g.kg(-1).min(-1)) significantly reduced HR by 11% without changing blood pressure (BP) and CI, whereas higher doses (>= 3.0 mu g.kg(-1).min(-1)) tended to decrease BP and Cl while increasing PCWP and systemic vascular resistance. After treatment with landiolol (1.5 mu g.kg(-1).min(-1)), hemodynamic parameters such as PCWP, stroke volume index, SvO(2), rate pressure product, filling time/RR, E/e', and Tei index were significantly improved. Conclusions: A low-dose beta-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)