Milrinone in cardiac surgery
Center for Women's Health Advisory Board Seated l-r ; Dr. Elizabeth Ofili, Ms. Zabrina Furlow, Dr. Jennifer Campbell, Ms. Kay Willingham and Ms. Diane Larche' Standing l-r ; Dr. Hilton Hudson, Dr. Shelia Robinson, Ms. Gwen Taylor, Dr. Rosalyn Scott and Dr. Sylvia Swilley pictured but not a part of advisory board ; Mr. Danny Clark.
Analytic Methods For each investigation, two probes were inserted, and the glycerol and ethanol results were the mean of the values of the two probes. Glycerol in dialysate 10 l ; and in plasma 20 l ; was analyzed with an ultrasensitive radiometric method 8 the intra- and interassay variabilities were 5 and 9.2%, respectively. Ethanol in dialysate and in perfusate 5 l ; was determined with an enzymatic method 6 the intra- and interassay variabilities were 3 and 4.5%, respectively. Plasma nonesterified fatty acids NEFA ; and lactate were determined with an enzymatic procedure Wako, Unipath, Dardilly, France ; and an automated analyzer YSI 27, Bioblock Scientific, Illkirch, France ; , respectively. Plasma glucose was determined with a glucose oxidase technique Biotrol, Merck-Clevenot, Nogent-sur-Marne, France ; . Plasma immunoreactive insulin was measured with the use of an RIA kit from ERIA Diagnostics Pasteur Marnes-la-Coquette, France ; . Plasma epinephrine and norepinephrine were assayed in 1-ml aliquots of plasma by high-pressure liquid chromatography with the use of electrochemical amperometric ; detection 26 the detection limit was 20 pg sample, day-to-day variability was 4%, and within-run variability was 3%. Statistical Analysis All the values are expressed as means SE. The responses to perfusions were analyzed with the use of a paired t-test. During perfusions, the EC glycerol concentration response and ethanol ratio value were calculated as the total integrated changes over baseline values [area under curve AUC ; from time t ; 15 to min and t 225 to t 255 min for the first experiment and from t 15 to min and t 195 min for the second experiment]. AUC was 135 to t calculated with the use of a trapezoidal method. Significant values are quoted in Tables 1 and 2. P 0.05 was considered statistically significant.
22. Izzat MB, West RR, Ragoonanan C, Angelini GD. Effect of systemic vasodilators on internal mammary artery flow: implications for postoperative treatment after myocardial revascularization. J Thorac Cardiovasc Surg. 1994; 108 1 ; : 82-5. 23. Cooper GJ, Wilkinson GA, Angelini GD. Overcoming perioperative spasm of the internal mammary artery: which is the best vasodilator? J Thorac Cardiovasc Surg. 1992; 104 2 ; : 465-8. 24. Vilandt J, Kjaergard H, Aggestrup S, Andreasen JJ, Olesen A. Intraluminal papaverine with pH 3 doubles blood flow in the internal mammary artery. Scand Cardiovasc J. 1999; 33 6 ; : 330-2. 25. Mayranpaa M, Simpanen J, Hess MW, Werkkala K, Kovanen PT. Arterial endothelial denudation by intraluminal use of papaverine-NaCl solution in coronary bypass surgery. Eur J Cardiothorac Surg. 2004; 25 4 ; : 560-6. 26. He GW, Yang CQ. Use of verapamil and nitroglycerin solution in preparation of radial artery for coronary grafting. Ann Thorac Surg. 1996; 61 2 ; : 610-4. 27. Mussa S, Guzik TJ, Black E, Dipp MA, Chanon KM, Taggart DP. Comparative efficacies and durations of action of phenoxybenzamine, verapamil nitroglycerin solution , and papaverine as topical antispasmodics for radial coronary bypass grafting. J Thorac Cardiovasc Surg. 2003; 126 6 ; : 1798-805. 28. Sasson L, Cohen AJ, Hamptman E, Schanchner A. Effect of topical vasodilators on internal mammary arteries. Ann Thorac Surg 1995; 59 2 ; : 494-6. 29. Zabeeda D, Medalion B, Jackobshvilli S, Ezra S, Schachner A, Cohen AJ. Comparison of systemic vasodilators: effects on flow in internal mammary and radial arteries. Ann Thorac Surg. 2001; 71 1 ; : 138-41. 30. Lobato E, Janelle GM, Urdaneta F, Martin TD. Comparison of milrinone versus nitroglycerin, alone and in combination, on grafted internal mammary artery flow after cardiopulmonary bypass: effects of alpha-adrenergic stimulation. J Cardiothorac Vasc Anesth. 2001; 15 6 ; : 723-7. 31. Dipp MA, Nye PC, Taggart DP. Phenoxybenzamine is more effective and less harmful than papaverine in the prevention of radial artery vasospasm. Eur J Cardiothorac Surg. 2001; 19 4 ; : 482-6. 32. Brodman RF, Frame R, Camacho M, Hu E, Chen A, Hollinger I. Routine use of unilateral and bilateral radial arteries for coronary artery bypass graft surgery. J Coll Cardiol. 1996; 28 4 ; : 959-63. 33. Acar C, Jebara VA, Portoghese M, Viesen B, Pogny JY, Grare P, et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg. 1992; 54 4 ; : 652-60.
Milrinone in pediatrics
Milrinone is more often used today because it has a shorter half-life than inamrinone and is less likely to cause thrombocytopenia.48, 49 Milrinone is renally excreted with a half-life of around 11 2 to hours, so it requires 41 2 to hours to achieve nearsteady state concentrations if given without a loading dose. A slow milrinone IV loading dose 50 g kg over 10 minutes ; is followed by an IV infusion at a rate of 0.375 to 0.75 g kg per minute 375 to 750 ng kg per minute ; for 2 to 3 days. In renal failure the dose should be reduced. Adverse effects include nausea, vomiting, and hypotension. Calcium Although calcium ions play a critical role in myocardial contractile performance and impulse formation, retrospective and prospective studies in the cardiac arrest setting have shown no benefit from calcium administration.50, 51 Furthermore, high serum calcium levels induced by calcium administration may be detrimental. For this reason, calcium should not be used routinely to support circulation in the setting of cardiac arrest. When hyperkalemia, ionized hypocalcemia eg, after multiple blood transfusions ; , or calcium channel blocker toxicity is present, use of calcium is probably helpful.52 Ideally, ionized calcium concentration should be measured because total calcium concentration does not correlate well with ionized concentration in critically ill patients.53, 54 When necessary, a 10% solution 100 mg mL ; of calcium chloride can be given in a dose of 8 to mg kg of the salt usually 5 to 10 and repeated as necessary. The 10% solution contains 1.36 mEq of calcium or 27.2 mg elemental calcium per milliliter. ; Digitalis Digitalis preparations have limited use as inotropic agents in emergency cardiovascular care. Digitalis decreases the ventricular rate in some patients with atrial flutter or fibrillation by slowing atrioventricular nodal conduction. The toxic to therapeutic ratio is narrow, especially when potassium depletion is present. Digitalis toxicity may cause serious ventricular arrhythmias and precipitate cardiac arrest. Digoxinspecific antibody is available for the treatment of serious toxicity Digibind, Digitalis Antidote BM ; . Nitroglycerin Nitrates are used for their ability to relax vascular smooth muscle. Nitroglycerin is the initial treatment of choice for suspected ischemic-type pain or discomfort see Part 8: "Stabilization of the Patient With Acute Coronary Syndromes" ; . IV nitroglycerin is also an effective adjunct in the treatment of congestive heart failure from any cause, 55 and it may be useful in hypertensive emergencies, particularly if related to volume overload. The action of nitroglycerin is mediated through local endothelial production of nitric oxide, particularly in the venous capacitance system. Nitroglycerin is most effective in patients with increased intravascular volume. Hypovolemia blunts the beneficial hemodynamic effects of nitroglycerin and increases the risk of hypotension; nitrateinduced hypotension typically responds well to fluid replacement therapy. Other potential complications of use of IV.
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The case that was presented gives a classic illustration of the mild to moderate corneal verticillate deposition that occurs with prolonged amiodarone therapy. It is important to communicate the clinical information that is collected to the patient's internist or cardiologist Should the vision be affected in a serious manner, then it becomes a dilemma of whether or not to decrease or discontinue therapy. Fortunately, the visual acuity is usually not affected in a serious manner and this decision can be averted It would be an optimum clinical situation to be able to obtain baseline visual acuities, visual fields, fundus photography, and anterior segment photography on patients started on this medication. Then these patients could be monitored on a regular basis for ocular health changes. Communicating this information to the prescribing physician could open the door for better relationships in the medical community.
40 30 20 FIGURE 3. Panel A: Forearm blood flow FBF ; at rest and during forearm exercise in patients with chronic heart failure CHF ; studied before and after 24 hours of intravenous administration of milrinone MIL ; . Panel B: Forearm vascular resistance FVR ; at rest and duringforearm exercise in CHFpatients studied before and after 24 hours of intravenous MIL. Panel C: Percent forearm oxygen extraction at rest and during forearm exercise in CHF patients studied before and after 24 hours of intravenous MIL. Panel D: Forearm oxygen consumption at rest and during forearm exercise in CHF patients studied before and after 24 hours of intravenous MIL. o, Normal subjects day 1 A, pre-MIL; A, post-MIL. * p 0.01, * * p 0. 001 vs. pre-MIL. Exercise is expressed as force developed kg ; with each contraction and minoxidil.
Actions on arrhythmic manifestations depend on variables such as the initial state of conduction, drug concentration, and frequency. Homogeneously superfused Purkinje fibers. The characteristics of conduction observed in false tendons homogeneously superfused with ischemic solution were similar to those recorded from the ischemic gap preparations. Two-component upstrokes, foot potentials, and step delays, all of which are manifestations of nonhomogeneous propagation, were observed with careful titration of [K + and longitudinal mapping of the preparation. In this preparation milrinone produced similar effects on conduction, refractoriness, and reentry as in the ischemic gap model. Depolarization-induced automaticity. Most positive inotropic and dromotropic agents enhance normal automaticity in cardiac tissues and facilitate the occurrence of abnormal automatic activity.'8 19 It was therefore of interest to determine whether milrinone, at concentrations that affect conduction, also enhanced automaticity. Low concentrations of the drug produced no important changes in automatic activity at any level of membrane potential. Although higher concentrations enhanced automaticity at all levels of membrane potential. the effect was small when compared with that of a low concentration of isoproterenol. Ionic mechanisms. Although elucidation of the ionic mechanisms underlying the actions of milrinone is beyond the scope of this study, the results provide some insight. The electrical activity elicited by milrinone in K-inactivated fibers is consistent with slow response activity resulting from activation of the slow inward current. '1 The enhancement of depressed responses observed in K-depolarized fibers is likewise attributable to an increase in slow-channel activity since the maximum diastolic potential was always more positive than - 55 mV. Moreover, these actions of the drug were observed in the presence of propranolol and suppressed with the slow channel-blocking agent verapamil. Thus, the electrophysiologic actions of milrinone may be explained by an increase in the intensity of slow inward current through a mechanism other than f3-adrenergic-receptor stimulation. Possible mechanisms for this effect include a direct drug-induced facilitation of transmembrane calcium movement through the slow channels or, as suggested in a recent report, 2 an indirect facilitation through inhibition of.
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1. Samson D. High-dose therapy in multiple myeloma. Curr Opinion Haematol 1996; 3: 446452. Bjorkstrand B. European Group for Blood and Marrow Transplantation Registry. Studies in multiple myeloma. Semin Hematol 2001; 38: 219225. Gazitt Y, Reading CC, Hoffman R et al. Purified CD34 + LinThy + stem cells do not contain clonal myeloma cells. Blood 1995; 86: 381388. Lemoli RM, Fortuna A, Motta MR et al. Concomitant mobilisation of plasma cells and haemopoietic progenitors into peripheral blood of multiple myeloma patients: positive selection and transplantation of enriched CD34 + cells to remove circulating tumour cells. Blood 1996; 87: 16251634. Schiller G, Vescio R, Freytes C et al. Transplantation of CD34 + peripheral blood progenitor cells after high-dose chemotherapy for patients with advanced multiple myeloma. Blood 1995; 86: 390397. Gupta D, Bybee A, Cooke F et al. CD34 + -selected peripheral blood progenitor cell transplantation in patients with multiple myeloma: tumour cell contamination and outcome. Br J Haematol 1999; 104: 166177. Galy A, Rudraraju S, Baynes R, Klein J. Recovery of lymphocytes and dendritic cell subsets after autologous CD34 + cell transplantation. Bone Marrow Transplant 2000; 25: 12491255.
Following recovery, the nylon vest was again placed on the animal animals having been previously acclimated to the vest prior to surgery ; , and an infusion pump PANOMAT C-10; Disetronic Medical Systems, Saint Paul, MN ; secured in the vest pocket where it was connected to the externalized end of the PE-10 intrathecal catheter. An infusion of 0.9% w v ; Sodium Chloride for Injection, USP at 50 l was initiated to ensure catheter patency prior to infusion of Test Article and mirapex.
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In 1984, van der Meer and colleagues described six patients with periodic fever and a constantly elevated serum polyclonal IgD and called the syndrome hyperimmunoglobulinemia D and periodic fever syndrome HIDS ; . HIDS is an autosomal recessive disorder, and to date more than 150 familial and isolated cases are known Drenth et al., 1994 ; . It should be distinguished from other periodic fever syndromes, such as the autosomal recessive familial Mediterranean fever and autosomal dominant tumor necrosis factor receptor-associated periodic fever syndrome : hids ; Drenth and van der Meer, 2000 ; . HIDS patients have a long history of recurrent attacks of fever, frequently preceded by chills and accompanied by headache, bilateral cervical lymphadenopathy, and occasionally by oral and vaginal aphthous ulcers, abdominal pain, and diarrhea. Laboratory analyses invariably reveal an acute phase response during atDr. A. Simon is a recipient of the Dutch Organization for Scientific Research Fellowship for Clinical Investigators KWO 920-03-116 ; . Dr. Joost P. H. Drenth is an Investigator of the Royal Netherlands Academy of Arts and Sciences and mitomycin.
Milrinone pediatrics
Engraftment occurred in 94% regardless of the source of stem cells with an additional 1% subsequently losing the graft. The median times to neutrophil 0.5 109 L ; and platelet 50 109 L ; recovery were 14 days range, 0-393 days ; and 14 days range, 0-374 days ; , respectively. There was a significant difference between patients receiving peripheral blood stem cells PBSCs ; and marrow in the time to neutrophil recovery 13 versus 16 days, P .001 ; and to platelet recovery 13 versus 22 days, P .001 ; . All patients receiving marrow became neutropenic and only one did not become thrombocytopenic, whereas 10% of those receiving PBSCs had a neutrophil count more than 0.5 109 L at all times, and 13% did not become thrombocytopenic 50 109 L ; . Chimerism data were available on 190 patients. At best, 81% achieved full donor chimerism and 86% were greater than 95% donor. On subsequent analysis this had fallen to 74% for full donor and to 80% for greater than 95% donor.
Recessions treated with CRF-CTG and GTR-CM was much smaller in patients qualified for treatment CRF-CTG 0.65 mm ; which resulted from conditions of qualifications before treatment. There was noticed a small decrease of keratinized gingiva thickness in comparison between examination results before treatment and after 12, 24 and 60 months. In addition, 5 years after the treatment with both methods the average thickness increase still remained compared with the initial state, bigger for CRF-CTG 1, 17 mm ; than for GTR-CM 1.05 mm ; . Usage of connective tissue graft method resulted in the significant decrease of that value compared with observations between 12, 24 and 60 months and between 24 and 60 months. For GTR-CM the situation was stable between 12 and 24 months, next the value of that parameter decreased significantly. There were no big changes of average TKT values in inter-group analyses during 12, 24 and 60 months Tab. 4 and mitotane.
Use of the drug needs to be discontinued for only 1 or 2 days before the tests. A difference in the blood pressure in the 2 arms may occasionally produce a false positive result in patients with either paroxysmal or sustained hypertension. The following case serves as an example. The basal blood pressure in a patient varied greatly in the 2 arms. When the blood pressure was measured on the arm with the highest pressure, it fell 80 mm. systolic and 40 mm. diastolic after the intravenous injection of Regitine. This could easily have been interpreted as a positive reaction to a pheochromocytoma. However this decrease only equalized the pressures in the 2 arms. When the blood pressures were determined simultaneously in the 2 arms, there was little or no fall in the blood pressure in either arm following the intravenous injection of 5 mg. of Regitine. If a tumor were present, a pronounced fall would have occurred on both sides. Therefore, the blood pressure is measured routinely on both arms of all patients and if there is any disparity, blood pressure is determined simultaneously in both arms during the pharmacologic tests. The pharmacologic tests have been of great aid in making a diagnosis of pheochromocytoma, but because of reasons given previously they are not always successful or accurate. If the results of the tests with histamine or Regitine are doubtful or negative when the clinical evidence is strongly indicative of a pheochromocytoma, then the results of the tests should be questioned and the tests should be repeated, or a test with one of the other drugs should be used. No one single test is always completely reliable. If doubt remains as to the accuracy of the diagnosis, measurement of the quantity of epinephrine and norepinephrine, both in the urine and the blood, may be helpful.
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Effect on pulmonary embolism: There was no significant difference for OAC when used as an adjuvant intervention RR 0.42, 95% CI: 0.10 to 1.75, three studies ; Figure 46, Appendix E ; . Effect on proximal DVT: There was no significant difference for OAC when used as an adjuvant intervention RR 0.70, 95% CI: 0.28 to 1.73, two studies ; Figure 47, Appendix E ; . Effect on major bleeding: There was no significant difference in major bleeding events when OACs were used as an adjuvant intervention RR 2.84, 95% CI: 0.57 to 14.19, three studies ; Figure 48, Appendix E ; . 6.2.2.3 Adjusted vs fixed lower ; dose oral anticoagulants We identified one systematic review with two RCTs444 and one additional RCT59 that compared adjusted dose oral anticoagulants with fixed dose in a total of 567 participants Evidence Table 26, Appendix D ; . The adjusted dose studies all gave the first dose preoperatively and continued the regimen for between three days and six weeks postoperatively. The fixed dose regimens were all started preoperatively and continued for between 14 days and 6 weeks postoperatively. Effect on DVT: Adjusted-dose OAC reduced the risk of DVT by 49% RR 0.51, 95% CI: 0.30 to 0.85, three studies ; compared to fixed dose OAC Figure 49, Appendix E ; . This result was determined almost entirely by the results of one study158. Effect on pulmonary embolism: Two studies reported PE rates. Only one event was observed RR 2.97, 95% CI: 0.12 to 72.01 ; Figure 50, Appendix E ; . Effect on proximal DVT: There was no significant difference between adjusted and fixed dose oral anticoagulants RR 0.36, 95% CI: 0.12 to 1.09, one study ; Figure 51, Appendix E ; . Effect on major bleeding: There was no significant difference between adjusted and fixed dose OAC RR 1.22, 95% CI: 0.47 to 3.18, two studies ; Figure 52, Appendix E ; . 6.2.2.4 Timing of initiation of oral anticoagulants We identified two studies167, 509 with 321 participants that compared timing of initiation of OAC Evidence Table 27, Appendix D ; . In one study167, patients were randomised to receive warfarin started 10-14 days preoperatively or the night before surgery. In the second study, patients received acenocoumarol begun either four days preoperatively or on the night before surgery. 6.2.2.5 and modafinil.
Smith, H.M., 1942b. Remarks on the Mexican king snakes of the triangulum group. Proceedings of the Rochester Academy of Science, 8: 196-207. Smith, H.M., 1944. Snakes of the Hoogstraal expe-ditions to northern Mexico. Field Museum of Natu-ral History, Zoological Series, 29 8 ; : 135-152. Smith, H.M. and Brodie, J., Edmund D., 1982. A guide to field identification reptiles of North Amer-ica. Golden Press, New York, 240 pp. Staub, R.E., 1991. Summary of workshop on egg incubation. In: R.E. Staub Editor ; , Captive propa-gation and husbandry of reptiles and amphibians. Northern California Herpetological Society Special Publication. Northern California Herpetological Society, pp. 119-120. Stejneger, L.H. and Barbour, T., 1917. A check list of North American amphibians and reptiles. Har-vard University, Cambridge, 125 pp. Strecker, J.K., 1915. Reptiles and amphibians of Texas. Baylor Bulletin, 18 4 ; . Baylor University Press, Waco, Texas, 82 pp. Switak, K.H., 1984. The life of desert reptiles and amphibians. Privately bound, San Fransisco, 32 pp. Tanzer, E.C., 1970. Polymorphism in the mexicana complex of kingsnakes, with notes on their natural history. Herpetologica, 26 4 ; : 419-428. Tennant, A., 1984. The snakes of Texas. Texas Monthly Press, Austin, TX, 561 pp. Tennant, A. et al., 1998. A Field Guide to Texas Snakes. Gulf Publishing Company, Houston, 291 pp. Thompson, H., 1993. Snakes Alive!, Texas Month-ly, pp. 60-63. Trutnau, L., 1975. Angst und Bewunderung, Teufel und Gttin. Die faszinierende Trans-Pecos-Kningsnatter [Fear and admiration, devil and god-dess The fascinating Trans Pecos kingsnake]. Aquarium magazine, 9 11 ; : 357359. [In German] Trutnau, L., 1984. Durch Nachzucht erhalten: Die TransPecos-Knigsnatter [Obtained by breeding: the Trans Pecos kingsnake]. Aquarium magazine, 18 10 ; : 496-499. [In German] Trutnau, L., 1988. Schlangen im Terrarium: Band 1. Ungiftige Schlangen [Snakes in the terrarium, vol. 1 Nonvenomous snakes]. Verlag Eugen Ul-mer, Stuttgart, 256 pp. [In German] Trutnau, L., 1990. Breeding the Grey-banded Kingsnake. Tropical Fish Hobbyist 2 ; : 28-35. Trutnau, L., 1999. Bemerkungen zur Biologie, Pflege und and milrinone.
Milrinone wikipedia
1. Cuffe MS, Califf RM Adams KF Jr., et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 2002; 287: 15417. Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med 2001; 345: 143543. Forrester JS, Diamond G, Chatterjee K, Swan HJ. Medical therapy of acute myocardial infarction by application of hemodynamic subsets second of two parts ; . N Engl J Med 1976; 295: 1404 Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA 1989; 261: 884 Cohn JN, Johnson GR, Shabetai R, et al. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart and modicon.
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Empirically, with or without enhanced vasodilation. Conversely, patients with profile C wet-cold ; might require hospitalization for more intensive therapy to achieve adequate diuresis, perhaps even guided by serial invasive hemodynamic measurements. A recent trial evaluating the effects of short-term milrinone on length of hospitalization and 60-day mortality showed that routine use of inotropic therapy in patients with NYHA class III IV symptoms results in increased short-term morbidity 1 ; . It possible that profile C may identify a subset of patients within those with NYHA class III IV symptoms in whom the riskbenefit ratio of short-term inotropic therapy differs. Clinical profiling may also help guide titration of betablocker therapy. Patients with profile A may tolerate initiation and up-titration of beta-blockers with the success observed in major trials, whereas profile B might represent a population where chronic beta-blocker therapy could be maintained but initiation or up-titration deferred until restoration of profile A. Conversely, determination of profile C might lead to a decrease or withdrawal of recently initiated beta-blockers until better compensation is achieved. The greater use of beta-blockers on admission in patients with profile A relative to those with profiles B and C is consistent with this management strategy. The prognostic information provided by clinical profiles may also help guide listing for transplantation in patients where oxygen consumption measures do not provide an obvious mortality benefit with transplantation 25 ; . In this cohort, the mean peak oxygen consumption ranged from 10 to 14 min, regardless of clinical profile. Thus, in hospitalized patients who are too sick to do an exercise stress test or whose last reported oxygen consumption does not reflect their present clinical status, clinical profiles may be useful. Although we propose ways in which clinical profiles might be used to guide the treatment of chronic HF, there are no data to support their utility for this indication. This question will be partially addressed by the ongoing multicenter Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness ESCAPE ; evaluating the correlation of clinical profiles to hemodynamic measurements and the success of clinical assessment-based versus catheter-guided therapy 27 ; . Similar to prior reports 4, 22 ; , profile L dry-cold ; was uncommon in this cohort. This grouping probably represents the few patients with HF who have significantly reduced cardiac reserve with a decreased tendency towards congestion. Alternatively, it might describe patients with severely dilated ventricles and anatomic mitral regurgitation who develop symptoms with minimal exertion. Patients with profile L, in particular, may benefit from interventions such as biventricular pacing, mitral valve repair, and surgical ventricular remodeling aimed at improving myocardial efficiency and molindone.
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Corresponding address: Room F4-221, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. Tel: 31-205664380; Fax: 31-206972286 and minoxidil.
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