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Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery

[La milrinone améliore la fonction systolique mais non la fonction diastolique pendant la chirurgie de pontage aortocoronarien]

Pierre Couture, MD FRCPC^*, André Y. Denault, MD FRCPC^*, Michel Pellerin, MD FRCPS and Jean-Claude Tardif, MD FRCPC

^* From the Departments of Anesthesiology,
Cardiac Surgery, and
Medicine, Montreal Heart Institute, University of Montréal, Montréal, Québec, Canada.

Address correspondence to: Dr. Pierre Couture, Department of Anesthesiology, Montreal Heart Institute, 5000 Bélanger St. East, Montréal, Québec H1T1C8, Canada. Phone: 514-376-3330, ext. 3732; Fax: 514-376-1355; E-mail: pierre.couture{at}icm-mhi.org Supported by Dr. Earl Wynands Research Award in Cardiovascular Anesthesia, 2001.

Purpose: To evaluate the effect of milrinone on diastolic function during coronary artery bypass grafting surgery (CABG).

Methods: Fifty patients undergoing CABG were randomized to receive a bolus and infusion of milrinone or placebo before cardiopulmonary bypass (CPB) until skin closure. Hemodynamic and transesophageal echocardiographic measurements of systolic and diastolic function were obtained. Pulsed wave Doppler measurements of the early (E wave) and atrial components (A wave) of the transmitral (TMF) and transtricuspid (TTF) flows, and systolic (S wave), diastolic (D wave) and atrial components (Ar) of the pulmonary (PVF) and hepatic venous blood flow (HVF) velocities were performed. Early and atrial components of the mitral (Em and Am waves) and tricuspid annulus velocities (Et and At waves) were assessed by tissue Doppler imaging (TDI). Assessment of diastolic dysfunction was graded from normal to severe using a scale score.

Results: Cardiac index and heart rate were higher in the milrinone group compared to placebo after the administration of study drug (2.8 ± 0.6 vs 2.1 ± 0.5 L·min^–1m^–2) (P < 0.0001) and (67 ± 8 vs 60 ± 12 beats·min^–1) (P < 0.05) respectively. There were no changes in left and right ventricular diastolic dysfunction scores between study groups. Higher PVF S wave, HVF S wave, TTF A wave and At measured by TDI in the milrinone group compared with placebo suggested an improvement in ventricular systolic and atrial contraction.

Conclusion: Distinct from its effects on systolic function, milrinone administered before CPB is not with associated improved biventricular diastolic function in patients undergoing CABG.