Effects Of Non - Short - Term Intravenous Phosphodiesterase Inhibitors On Chronic Heart Failure In Elderly Males

[Backgrounds]As the acceleration of processing of the population aging, the incidence of chronic heart failure is also rising constantly. Compared to acute myocardial infarction and common tumors (lung, colon, prostate, bladder and breast), the5-year survival rate of chronic heart failure is the worst except lung cancer, which is about25%. Therefore, for the studies of treatments of elderly patients with chronic heart failure become much more important, especially for oldest-old patients who are over80-year-old. Since1987, milrinone appeared on the market of United States for the first time, intravenous milrinone has been widely used to improve cardiac function of acute/chronic heart failure patients. Via highly selective inhibition of the phosphodiesterase Ⅲ (PDE Ⅲ) on cardiac muscles and vascular smooth muscles, milrinone reduces cyclic adenosine monophosphate (cAMP) degradation and increases sarcoplasmic reticulum calcium releasing. This reaction can improve myocardial contractility in cardiac myocytes by a positive inotropic effect caused by the excitation-contraction coupling reaction. At the meantime, by promoting actin and myosin dissociation, myocardial diastolic velocity accelerates. Thereby diastolic ventricular compliance increases. For all the reasons above, milrinone is widely used in heart failure patients with normal ejection fraction or reduced ejection fraction. For elderly patients with chronic heart failure patients, milrinone can improve patients’ clinical symptoms and hemodynamic index through various aspects. Therefore, we assume that non-short-term intravenous milrinone using in oldest-old male patients with chronic heart failure can ameliorate patients’cardiac function.During clinical working, we found that some elderly patients showed significant heart failure even after long time using of ACEI/ARB, β-blockers, aldosterone receptor antagonists, diuretics and other standard therapies. Because of their elder ages, these patients had lost the non-drug treatment opportunities for ameliorating cardiac functions. Therefore intravenous milrinone was used repeatedly when standard therapies showed poor effects. We observed that repeatedly non-short-term intravenous using of milrinone improved patients’symptoms, physical signs and living quality.To understand the nor-short-term intravenous using of milrinone’s impact on the oldest-old patients who suffered from chronic heart failure. We retrospectively study the oldest-old patients who are over80years old in Huadong hospital during January2006to December2009, and then retrospectively analyze those patients who were under treatment of non-short-term intravenous milrinone.[Aims]To invest the impact of non-short-term intravenous milrinone using on oldest-old patients with chronic heart failure by thoroughly study the changes in indexes of cardiac function in echocardiographic, Holter system as well as renal function.[Materials and methods]We assigned22cases of oldest-old male patients with chronic heart failure who were in the long-term intravenous milrinone treatment, and then retrospectively analyzing the indexes of cardiac function in echocardiographic, Holter system, as well as some important biochemical tests. All data were statistically processed by SPSS17.0software. Normal distribution data is formulated with (mean±standard difference). Paired t-test analysis is applied for data of indexes of cardiac function and biochemical tests and when P<0.05, the result is considered to be statistically significant difference.[Results]1. Left ventricular ejection fraction (LVEF) of these patients before and after treatment of non-short-term intravenous milrinone significantly increased from41.45±3.24%to44.54±3.59%(P<0.01). Fractional shortening (FS) significantly increased from21.95±2.40%to23.59±2.89%(P<0.01). Left ventricular end-systolic dimension (LVDs) significantly reduced from43.05±2.85mm to40.59±2.82mm (P<0.01). Left ventricular end-diastolic dimension (LVDd) significantly reduced from55.14±3.14mm to53.14±3.28mm(P<0.01).2. There was no significant difference in the incidence of ventricular arrhythmias before and after non-short-term intravenous milrinone using.3. Serum sodium concentration significantly increased from138.59±3.13mmol/l to140.86±3.73mmol/l (P<0.01). At the meantime, there were no significant differences in blood urea nitrogen, serum creatinine concentration and uric acid. [Conclusion]1. Non-short-term intravenous use of milrinone in oldest-old patients who suffered from chronic heart failure can significantly improve the left ventricle systolic function. There were significant differences in LVEF, FS, LVDd and LVDs.2. There was no significant difference in the incidence of ventricular arrhythmias before and after non-short-term intravenous milrinone using.3. Non-short-term intravenous use of milrinone in oldest-old patients who suffered from chronic heart failure can significantly return the serum sodium concentration to normal. There was significant difference in serum sodium concentration.4. There was no significant difference in renal function before and after non-short-term intravenous use of milrinone in oldest-old patients who suffered from chronic heart failure.