Myocardial Reserve in Advanced Heart Failure Patients Evaluated by Right Heart Catheterization with Milrinone Inotrope Challenge

What this Trial Is About

Researchers are evaluating whether differences in myocardial reserve, measured by invasive hemodynamics, can predict clinical outcomes in patients with heart failure. This prospective, observational, crossover study focuses on patients undergoing right heart catheterization (RHC) for advanced heart failure evaluation or worsening clinical status. It includes patients considered for advanced therapies such as left ventricular assist device (LVAD), heart transplant, inotrope therapy, or counter-pulsation devices, as well as those assessed before valve surgery for aortic insufficiency or mitral regurgitation. Participants are randomized into two groups: one receives an inotropic agent called milrinone, given as a bolus dose of 50 mcg/kg followed by a maintenance infusion if needed, and the other group does not receive milrinone. Those without cardiogenic shock will not receive milrinone. The study involves monitoring invasive hemodynamic changes using a pulmonary artery catheter at baseline and several time points up to 72 hours after the inotrope challenge. During the study, patients undergo repeated cardiac output measurements and invasive hemodynamic assessments. Researchers track advanced heart failure therapies, inotrope use, hospital discharge, and survival over a two-year period. Secondary outcomes include duration on durable support and LVAD decommissioning measures. The total follow-up includes monitoring up to two years to assess long-term clinical outcomes related to myocardial reserve.

Cardiac Power Output in Cardiogenic Shock Patients