Hemodynamic Effects of Nisoldipine in Patients with Severe Heart Failure

  • A. Kimchi
  • A. G. Ellrodt
  • P. K. Shah
  • M. S. Riedinger
  • Y. Charuzi
  • D. S. Berman
  • H. J. C. Swan
Conference paper

Summary

To determine the effects of nisoldipine in patients with severe left ventricular dysfunction, we studied hemodynamic changes after oral nisoldipine in 14 patients with severe chronic congestive heart failure . They included 9 males and 5 females, with a mean age of 72 years. Three patients were classified as NYHA Class III and 11 patients, as Class IV . Baseline hemodynamics included a mean left ventricular ejection fraction of 26% ± 14% and a mean cardiac index of 1.98 ± 0.34 liter min−1m−2. Beta blockers, vasodilators or inotropic drugs were discontinued. Heart rate, blood pressure, pulmonary artery wedge pressure, and cardiac output were stable for at least 1 h prior to the study. Baseline hemodynamic measurements and radionuclide angiocardiography were then obtained. An oral dose of nisoldipine (5, 10, or 20 mg) in a double-blind fashion was administered according to random assignment. Measurements of hemodynamics were obtained at 30 min, 1,2,3,4, 5, 6, 7, and 8 h thereafter. Repeat radionuclide imaging was performed 2 and 3 h following nisoldipine administration. Hemodynamic measurements included: heart rate (HR, bpm), arterial pressure (AP, mmHg), right atrial pressure (RAP, mmHg), pulmonary arterial pressure (PAP, mmHg), pulmonary capillary wedge pressure (PCW, mmHg), systemic vascular resistance (SVR, dyn s−1 cm−5), left ventricular ejection fraction (LVEF%), cardiac index (CI, liter min−1 m−2) and stroke volume index (SVI, cc b−1 m−2).

Peak systemic hemodynamic effect or maximal fall in systemic vascular resistance was variable in time of onset for individuals. The maximal fall in systemic vascular resistance was obtained an average of 2.8 ± 1.6 h after the oral dose of nisoldipine. Since there were wide variations among individuals with regard to the time of peak systemic hemodynamic effect , we analyzed individual hemodynamic changes at peak effect of nisoldipine.

We conclude from this study that acute administration of oral nisoldipine may be efficacious in certain patients with chronic congestive heart failure. Improved left ventricular function with nisoldipine may be associated with reduction in mean PCW and determinants of afterload, i.e. AP and SVR.

Keywords

Radionuclide Cardiol Propranolol Digoxin Verapamil 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • A. Kimchi
  • A. G. Ellrodt
  • P. K. Shah
  • M. S. Riedinger
  • Y. Charuzi
  • D. S. Berman
  • H. J. C. Swan

There are no affiliations available

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