Predictors of clinical outcome in advanced heart failure patients on continuous intravenous milrinone therapy

Home-based milrinone therapy (HMT) is used as a bridge to cardiac transplant (CT). The safety, efficacy, and predictors of success of HMT were assessed. Forty-five patients with heart failure, referred for CT, were prospectively studied. After initial assessment, low-dose milrinone was titrated based on clinical response. Hemodynamic status was then reevaluated. Thirty-nine patients were discharged on HMT. Patients needing a left ventricular assist device (LVAD) despite milrinone (group I) and those not requiring LVAD (group II) were compared. Six of the 45 patients were ineligible for CT; 16 of 39 required LVAD as a bridge to CT despite milrinone (group I); 23 were stable on milrinone and did not require LVAD (group II). Group I was younger than group II (mean age 38.4 ± 14.5 years vs. 57.3 ± 5.9 years, p < 0.001). Initial acute response to intravenous milrinone [e.g., fall in the PCWP (-10.7 ± 9.5 vs. -2.7 ± 10.4, p = 0.02), rise in pulmonary artery oxygen saturations (16.5 ± 8.7 vs. 7.3 ± 10.9, p = 0.05)] was significantly better in group II than in group I. Acute hemodynamic response to milrinone predicts success of HMT as a bridge to CT.