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.
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References
Low RI, Takeda P, Mason DT, DeMaria AN (1982) The effects of calcium channel blocking agents on cardiovascular function. Am J Cardiol 49: 547–553
Ellrodt AG, Singh BN (1983) Clinical applications of slow channel blocking compounds. Pharmacal Ther 23: 1–43
Schwartz A, Matlib MA, Balwierczak J, Lathrop DA (1985) Pharmacology of calcium antagonists. Am J Cardiol 55: 3C–7C
Josephson MA, Singh BN (1985) Use of calcium antagonists in ventricular dysfunction. Am J Cardiol 55: 81B–88B
Baughman K (1986) Calcium channel blocking agents in congestive heart failure. Am J Med 80 [suppl 213]: 46–50
Colucci WS (1987) Usefulness of calcium antagonists for congestive heart failure. Am J Cardiol 59: 52B–58B
O’Rourke RA, Walsh RA (1982) Experience with calcium antagonist drugs in congestive heart failure. Am J Cardiol 59: 64B–69B
Kazda S, Garthoff B, Meyer H, Schlossmann K, Stoepel K, Towart R, Vater W, Wehinger E (1980) Pharmacology of a new calcium antagonistic compound, isobutyl methyl 1, 4-dihydro-2, 6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinedicarboxylate (nisoldipine, Bay k 5552). Arzneimittelforsch Drug Res 30 (II): 2144–2162
Vogt A, Neuhaus KL, Kreuzer H (1980) Hemodynamic effects of the new vasodilator drug Bay k 5552 in man. Arzneimittelforsch Drug Res 32 (II): 2162–2164
Warltier DC, Meils CM, Gross GJ, Brooks HL (1981) Blood flow in normal and acutely ischemic myocardium after verapamil, diltiazem and nisoldipine (Bay k 5552), a new dihydropyridine calcium antagonist. J Pharmacol and Exp Therap 218: 296–302
Maxwell GM, Crompton S, Rencis V (1982) Effect of nisoldipine upon the general and coronary hemodynamics of the anesthetized dog. J Cardiovasc Pharmacol 4: 393–397
Serruys PW, Suryapranata H, Planellas J, Wijns W, Vanhaleweyk GLJ, Soward A, Jaski BE, Hugenholtz PG (1985) Acute effects of intravenous Nisoldipine on left ventricular function and coronary hemodynamics. Am J Cardiol 56: 140–146
Soward AL, DeFeyter PJ, Hugenholtz PG, Serruys PW (1986) Coronary and systemic hemodynamic effects of intravenous nisoldipine. Am J Cardiol 58: 1199–1203
Soward AL, DeFeyter PJ, Hugenholtz PG, Serruys PW (1986) Maintenance of increased or blood flow in excess of demand by nisoldipine administered as an intravenous infusion. Am J Cardiol 58: 1204–1208
Kimchi A, Ellrodt AG, Shah PK, Riedinger MS, Berman DS, Swan HJC, Murata GH (1985) Salutary hemodynamic effects of nisoldipine (Bay k 5552), a new calcium channel blocker, in patients with severe chronic congestive heart failure. JACC 5: 420
Kimchi A, Ellrodt AG, Charuzi Y, Shell W, Murata GM (1985) Salutary hemodynamic and sustained clinical beneficial effects of nisoldipine, a new calcium channel blocker, in patients with recurrent ischemia and severe heart failure. Am Heart J 110: 496–498
Kimchi A, Rozanski A, Fletcher C, Maddahi J, Swan HJC, Berman D (1985) Reversal of rest myocardial asynergy during exercise: a radionuclide scintigraphic study. JACC 6: 1004–1010
Kimchi A, Ellrodt G, Berman D, Riedinger M, Swan HJC, Murata G (1984) Right ventricular performance in septic shock: A combined radionuclide and hemodynamic study. JACC 4: 945–951
Vogt A, Kreuzer H (1983) Hemodynamic effects of Nisoldipine in chronic congestive heart failure. Arzneimittelforsch Drug Res 33 (I): 877–879
Klepzig M, Straver BB (1985) Nisoldipine for treatment of heart failure? Eur J Clin Invest 15: A11
Kiowski W, Erne P, Pfisterer M, Muller J, Burkart F (1985) Hemodynamic effects of nisoldipine in patients with severe left ventricular failure. Circulation 72: III-407
Nienaber CA, Spielmann RP, Clausen A (1985) Acute hemodynamic response to intravenous nisoldipine in ischemic cardiomyopathy- comparison with nifedipine. Circulation 92: III-407
Schmidt WG, Essen RV, Flachskampf FA, Schmitz E (1986) Hemodynamic effects of Nisoldipine in acute cardiac failure after myocardial infarction. JACC 72: 180A
Chew YC, Hecht HS, Colleit JT, McAllister RG, Singe BN (1981) Influence of severity of ventricular dysfunction on hemodynamic responses to intravenously administered verapamil ischemic heart disease. Am J Cardiol 47: 917–922
Ferlinz J, Citron PD (1983) Hemodynamic and myocardial performance characteristics after Verapamil use in congestive heart failure. Am J Cardiol 51: 1339–1345
Guazzi MD, Cipolla C, Bella PD, Fabbiocchi F, Montorsi P, Sganzerla P (1984) Disparate unloading efficacy of the calcium channel blockers, verapamil and nifedipine, on the failing hypertensive left ventricle. Am Heart J 108: 116–123
Kopman EA (1985) Intravenous verapamil to relieve pulmonary congestion in patients with mitral valve disease. Anesthesiology 56: 374–376
Epstein ML, Kiel EA, Victorica BE (1985) Cardiac decompensation following Verapamil therapy in infants with supraventricular tachycardia. Pediatrics 75: 737–740
Bjornstad PO, Storstein L, Semb BKH (1986) Verapamil effects on left ventricular performance in patients with congestive heart failure studied with echocardiography before and after cardiac surgery. Scan J Thor Cardiovasc Surg 20: 61–66
Materne P, Legrand V, Vandormael M, Collignon P, Kulbertus HE (1984) Hemodynamic effects of intravenous Diltiazem with impaired left ventricular function. Am J Cardiol 54: 733–737
Walsh RW, Porter CB, Starling MR, O’Rourke RA (1984) Beneficial hemodynamic effects of intravenous and oral Diltiazem in severe congestive heart failure. JACC Vol. 3, No. 4: 1044–1050
Strauss WE, Egan T, Mcintyre KM, Parisi AF (1985) Combination therapy with diltiazem and propranolol Precipitation of congestive heart failure. Clin Cardiol 8: 363–366
Polese A, Fiorentini C, Olivari MT, Guazzi MD (1979) Clinical use of a calcium antagonist agent (nifedipine) in acute pulmonary edema. Am J Med 66: 825–830
Gillmer DJ, Kark P (1980) Pulmonary oedema precipitated by nifedipine. Br Med J 280: 1420–1421
Matsumoto S, Ito T, Sada T, Takahashi M, Su KM, Ueda A, Okabe F, Cato M, Sekine I, Ito Y (1980) Hemodynamic effects of nifedipine in congestive heart failure. Am J Cardiol 46: 476–480
Brooks N, Cattell M, Pidgeon J, Balcon R (1980) Unpredictable response to nifedipine in severe cardiac failure. Br Med J 281: 1324
Cantelli I, Pavesi PC, Naccarella F, Bracchetti D (1981) Comparison of acute hemodynamic effects of nifedipine and isosorbide dinitrate in patients with heart failure following acute myocardial infarction. Int J Cardiol 1: 151–163
Ludbrook PA, Tiefenbrunn AJ, Sobel BE, Reed FR (1981) Influence of nifedipine on left ventricular systolic and diastolic function. Relationships to manifestations of ischemia and congestive failure. Am J Med 71: 683–692
Robson RH, Vishwanath MC (1982) Nifedipine and beta-blockade as a cause of cardiac failure. Br Med J 284: 104
Ludbrook PA, Tiefenbrunn AJ, Reed FR, Sobel BE (1982) Acute hemodynamic responses to sublingual nifedipine: Dependence on left ventricular function. Circulation 65: 489–498
Cantelli I, Pavesi PC, Parchi C, Naccarella F, Bracchetti D (1983) Acute hemodynamic effects of combined therapy with digoxin and nifedipine in patients with chronic heart failure. Am Heart J 106: 308–315
Elkayam U, Weber L, Torkan B, Berman D Rahimtoola SH (1983) Acute hemodynamic effect of oral nifedipine in severe chronic congestive heart failure. Am J Cardiol 52: 1041–1045
Leier CV, Patrick TJ, Hermiller J, Pacht KD, Huss P, Magorien RD, Unverferth DV (1984) Nifedipine in congestive heart failure: Effects on resting and exercise hemodynamics and regional blood flow. Am Heart J 108: 1461–1468
Elkayam U, Weber L, Torkan B, McKay CR, Rahimtoola SH (1984) Comparison of hemodynamic responses to nifedipine and nitroprusside in severe chronic congestive heart failure. Am J Cardiol 53: 1321–1325
Elkayam U, Weber R, McKay CR, Rahimtoola SH (1984) Differences in hemodynamic response to vasodilation due to calcium channel antagonism with nifedipine and direct -acting agonism with hydralazine in chronic refractory congestive heart failure. Am J Cardiol 54: 126–131
Magorien RD, Leier CV, Kolibash AJ, Bar bush TJ, Unverferth DV (1984) Beneficial effects of nifedipine on rest and exercise myocardial energetics in patients with congestive heart failure. Circulation 70: 884–890
Elkayam U, Weber L, Campese VM, Massry SG, Rahimtoola SH (1984) Renal hemodynamic effects of vasodilation with nifedipine and hydralazine in patients with heart failure. JACC 4: 1261–1267
Fifer MA, Colucci WS, Lorell BH, Jaski BE, Barry WH (1985) Inotropic, vascular and neurodocrine effects of nifedipine in heart failure: Comparison with nitroprusside. J Am Coli Cardiol 5: 731–737
Miller AB, Conetta DA, Bass TA (1985) Sublingual nifedipine: Acute effects in severe chronic congestive heart failure secondary to idiopathic dilated cardiomyopathy. Am J Cardiol 55: 1359–1362
Gertz MA, Falk RH, Skinner M, Cohen AS, Kyle RA (1985) Worsening of congestive heart failure in amyloid heart disease treated by calcium channel-blocking agents. Am J Cardiol 55: 1645
Elkayam U, Weber L, McKay C, Rahimtoola S (1985) Spectrum of acute hemodynamic effects of nifedipine in severe congestive heart failure. Am J Cardiol 56: 560–566
Kubo SH, Fox SC, Prida XE, Cody RJ (1985) Combined hemodynamic effects of nifedipine and nitroglycerin in congestive heart failure. Am Heart J 110: 1032–1034
Agostoni PG, DeCesare N, Doria E, Palese A, Tamborini G, Guazzi MD (1986) Afterload reduction: a comparison of captopril and nifedipine in dilated cardiomyopathy. Br Heart J 55: 391–399
Elkayam U, Roth A, Hsueh W, Weber L, Freidenberger L, Rahimtoola SH (1986) Neurohumoral consequences of vasodilator therapy with hydralazine and nifedipine in severe congestive heart failure. Am Heart J 111: 1130–1138
Lefkowitz CA, Moe GW, Armstrong PW (1987) A comparative evaluation of hemodynamic and neurohumoral effects of nitroglycerin and nifedipine in congestive heart failure. Am J Cardiol 59: 59B–63B
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Kimchi, A. et al. (1987). Hemodynamic Effects of Nisoldipine in Patients with Severe Heart Failure. In: Hugenholtz, P.G., Meyer, J. (eds) Nisoldipine 1987. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73010-8_48
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DOI: https://doi.org/10.1007/978-3-642-73010-8_48
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