Short term parenteral administration of amrinone to a patient of dilated cardiomyopathy with severe left ventricular dysfunction

Amrinone is an inotropic agent with a potent vasodilating, diuretic action. In contrast to dobutamine, it does not increase myocardial O₂ consumption. Potential usefulness of amrinone for a short term administration is well recognized but the criteria for clinical indication is not clear. We experienced a case, 47 y male, of congestive heart failure due to idiopathic dilated cardiomyopathy. On May 1995, the patient realized short of breath on stairs and he needed to take a rest at the half way of stairs. Chest roentgenogram showed increased cardio-thoracic ratio (57%) , electrocardiogram showed sinus tachycardia (120 b/min) with LAD, LAH and poor R wave progression in precordial leads (V1-V4). Echocardiogram showed dilated left ventricle and impaired contraction (LVDd 65 mm, Ds 60 mm, %EF 17%). He was hospitalized and catheterization was performed. Hemodynamic study revealed low output (CI 2.5 l/min/m²), high pulmonary wedge pressure (27 mmHg), and LVEDP (27 mmHg). Left ventriculogram showed dilated (EDVI 159 ml/m²) and diffusely hypokinetic (EF 13%) left ventricle. Hemodynamic monitoring was performed. Diuretics had a transient effect and the improvement of CI and PCWP could not be maintained. Intravenous infusion of amrinone (10 γ) was initiated and continued for 24 hours. PCWP decreased to 17 mmHg associated with an increase in CI (3.2 l/min/m²) and a decrease in pulmonary artery pressure. His deteriorated hemodynamic state, resistant to diuretics, was improved and maintained by the short-term intravenous administration of amrinone. The patient discharged with improved symptoms and he was asymptomatic for 10 months with medication including diuretics and an ACE inhibitor. Short term intravenous administration of amrinone was useful as a first choice therapy for the treatment of deteriorated hemodynamics in dilated cardiomyopathy.