Acute substantial benefit of inotropic therapy with amrinone on exercise hemodynamics and metabolism in severe congestive heart failure.

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Abstract
The acute hemodynamic and metabolic effects of amrinone during exercise were studied in 8 patients with severe congestive heart failure. The patients exercised to exhaustion on an upright bicycle ergometer at a fixed work load of 25 W. During the control period of exercise, exhaustion occurred at 3.16 .+-. 1.39 min. Stroke volume increased from 29.5 .+-. 5.8 to 38.7 .+-. 9.5 ml (P < 0.01), arteriovenous O2 difference from 7.6 .+-. 1.3 to 9.6 .+-. 0.6 ml/100 ml (P < 0.001), O2 consumption from 231 .+-. 38 to 468 .+-. 111 ml/min (P < 0.001) and arterial lactate concentration from 1.07 .+-. 0.25 to 5.02 .+-. 1.45 mmol/l (P < 0.01). During exercise after administration of amrinone, exhaustion occurred significantly later than during the control period: 6.28 .+-. 2.07 vs. 3.16 .+-. 1.39 min (P < 0.05). At a time equal to the point of exhaustion during the control period, stroke volume was significantly greater after amrinone (46.7 .+-. 9.8 vs. 38.7 .+-. 9.5 ml, P < 0.05), arteriovenous O2 difference and arterial lactate concentration were significantly lower (7.7 .+-. 0.9 vs. 9.6 .+-. 0.6 ml/100 ml [P < 0.05] and 2.96 .+-. 1.01 vs. 5.02 .+-. 1.45 mmol/l [P < 0.05], respectively) and O2 consumption was similar. At the point of exhaustion during exercise after amrinone, there were further increases to stroke volume (to 54.0 .+-. 11.6 ml, P < 0.05), and O2 consumption (to 674 .+-. 141 ml/min, P < 0.05), arteriovenous O2 difference and arterial lactate concentration reached values similar to those during control exercise. Amrinone increased exercise capacity, improved exercise hemodynamics and probably decreased anaerobic metabolism at a given duration of exercise.