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


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.


Congestive Heart Failure Mean Arterial Pressure Cardiac Index Systemic Vascular Resistance Pulmonary Capillary Wedge Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Low RI, Takeda P, Mason DT, DeMaria AN (1982) The effects of calcium channel blocking agents on cardiovascular function. Am J Cardiol 49: 547–553PubMedCrossRefGoogle Scholar
  2. 2.
    Ellrodt AG, Singh BN (1983) Clinical applications of slow channel blocking compounds. Pharmacal Ther 23: 1–43CrossRefGoogle Scholar
  3. 3.
    Schwartz A, Matlib MA, Balwierczak J, Lathrop DA (1985) Pharmacology of calcium antagonists. Am J Cardiol 55: 3C–7CPubMedCrossRefGoogle Scholar
  4. 4.
    Josephson MA, Singh BN (1985) Use of calcium antagonists in ventricular dysfunction. Am J Cardiol 55: 81B–88BPubMedCrossRefGoogle Scholar
  5. 5.
    Baughman K (1986) Calcium channel blocking agents in congestive heart failure. Am J Med 80 [suppl 213]: 46–50PubMedCrossRefGoogle Scholar
  6. 6.
    Colucci WS (1987) Usefulness of calcium antagonists for congestive heart failure. Am J Cardiol 59: 52B–58BPubMedCrossRefGoogle Scholar
  7. 7.
    O’Rourke RA, Walsh RA (1982) Experience with calcium antagonist drugs in congestive heart failure. Am J Cardiol 59: 64B–69BCrossRefGoogle Scholar
  8. 8.
    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): 2144–2162Google Scholar
  9. 9.
    Vogt A, Neuhaus KL, Kreuzer H (1980) Hemodynamic effects of the new vasodilator drug Bay k 5552 in man. Arzneimittelforsch Drug Res 32 (II): 2162–2164Google Scholar
  10. 10.
    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: 296–302Google Scholar
  11. 11.
    Maxwell GM, Crompton S, Rencis V (1982) Effect of nisoldipine upon the general and coronary hemodynamics of the anesthetized dog. J Cardiovasc Pharmacol 4: 393–397PubMedCrossRefGoogle Scholar
  12. 12.
    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: 140–146PubMedCrossRefGoogle Scholar
  13. 13.
    Soward AL, DeFeyter PJ, Hugenholtz PG, Serruys PW (1986) Coronary and systemic hemodynamic effects of intravenous nisoldipine. Am J Cardiol 58: 1199–1203PubMedCrossRefGoogle Scholar
  14. 14.
    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: 1204–1208PubMedCrossRefGoogle Scholar
  15. 15.
    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: 420Google Scholar
  16. 16.
    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: 496–498PubMedCrossRefGoogle Scholar
  17. 17.
    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: 1004–1010PubMedGoogle Scholar
  18. 18.
    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: 945–951PubMedGoogle Scholar
  19. 19.
    Vogt A, Kreuzer H (1983) Hemodynamic effects of Nisoldipine in chronic congestive heart failure. Arzneimittelforsch Drug Res 33 (I): 877–879Google Scholar
  20. 20.
    Klepzig M, Straver BB (1985) Nisoldipine for treatment of heart failure? Eur J Clin Invest 15: A11Google Scholar
  21. 21.
    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-407Google Scholar
  22. 22.
    Nienaber CA, Spielmann RP, Clausen A (1985) Acute hemodynamic response to intravenous nisoldipine in ischemic cardiomyopathy- comparison with nifedipine. Circulation 92: III-407Google Scholar
  23. 23.
    Schmidt WG, Essen RV, Flachskampf FA, Schmitz E (1986) Hemodynamic effects of Nisoldipine in acute cardiac failure after myocardial infarction. JACC 72: 180AGoogle Scholar
  24. 24.
    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: 917–922PubMedCrossRefGoogle Scholar
  25. 25.
    Ferlinz J, Citron PD (1983) Hemodynamic and myocardial performance characteristics after Verapamil use in congestive heart failure. Am J Cardiol 51: 1339–1345PubMedCrossRefGoogle Scholar
  26. 26.
    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: 116–123PubMedCrossRefGoogle Scholar
  27. 27.
    Kopman EA (1985) Intravenous verapamil to relieve pulmonary congestion in patients with mitral valve disease. Anesthesiology 56: 374–376Google Scholar
  28. 28.
    Epstein ML, Kiel EA, Victorica BE (1985) Cardiac decompensation following Verapamil therapy in infants with supraventricular tachycardia. Pediatrics 75: 737–740PubMedGoogle Scholar
  29. 29.
    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: 61–66CrossRefGoogle Scholar
  30. 30.
    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: 733–737PubMedCrossRefGoogle Scholar
  31. 31.
    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: 1044–1050PubMedGoogle Scholar
  32. 32.
    Strauss WE, Egan T, Mcintyre KM, Parisi AF (1985) Combination therapy with diltiazem and propranolol Precipitation of congestive heart failure. Clin Cardiol 8: 363–366PubMedCrossRefGoogle Scholar
  33. 33.
    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: 825–830PubMedCrossRefGoogle Scholar
  34. 34.
    Gillmer DJ, Kark P (1980) Pulmonary oedema precipitated by nifedipine. Br Med J 280: 1420–1421PubMedCrossRefGoogle Scholar
  35. 35.
    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: 476–480PubMedCrossRefGoogle Scholar
  36. 36.
    Brooks N, Cattell M, Pidgeon J, Balcon R (1980) Unpredictable response to nifedipine in severe cardiac failure. Br Med J 281: 1324PubMedCrossRefGoogle Scholar
  37. 37.
    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: 151–163PubMedCrossRefGoogle Scholar
  38. 38.
    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: 683–692PubMedCrossRefGoogle Scholar
  39. 39.
    Robson RH, Vishwanath MC (1982) Nifedipine and beta-blockade as a cause of cardiac failure. Br Med J 284: 104CrossRefGoogle Scholar
  40. 40.
    Ludbrook PA, Tiefenbrunn AJ, Reed FR, Sobel BE (1982) Acute hemodynamic responses to sublingual nifedipine: Dependence on left ventricular function. Circulation 65: 489–498PubMedCrossRefGoogle Scholar
  41. 41.
    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: 308–315PubMedCrossRefGoogle Scholar
  42. 42.
    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: 1041–1045PubMedCrossRefGoogle Scholar
  43. 43.
    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: 1461–1468PubMedCrossRefGoogle Scholar
  44. 44.
    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: 1321–1325PubMedCrossRefGoogle Scholar
  45. 45.
    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: 126–131PubMedCrossRefGoogle Scholar
  46. 46.
    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: 884–890PubMedCrossRefGoogle Scholar
  47. 47.
    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: 1261–1267PubMedGoogle Scholar
  48. 48.
    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: 731–737CrossRefGoogle Scholar
  49. 49.
    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: 1359–1362PubMedCrossRefGoogle Scholar
  50. 50.
    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: 1645PubMedCrossRefGoogle Scholar
  51. 51.
    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: 560–566PubMedCrossRefGoogle Scholar
  52. 52.
    Kubo SH, Fox SC, Prida XE, Cody RJ (1985) Combined hemodynamic effects of nifedipine and nitroglycerin in congestive heart failure. Am Heart J 110: 1032–1034PubMedCrossRefGoogle Scholar
  53. 53.
    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: 391–399PubMedCrossRefGoogle Scholar
  54. 54.
    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: 1130–1138PubMedCrossRefGoogle Scholar
  55. 55.
    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–63BPubMedCrossRefGoogle Scholar

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

Personalised recommendations