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Systemic and coronary hemodynamic effects of bepridil in patients with depressed left ventricular function
T De Marco1, P Deedwania, K Chatterjee
1Department of Medicine, University of California, San Francisco 94143-0124.
Insights
Oral bepridil therapy did not harm cardiac performance in patients with reduced ejection fraction. Its antianginal effects may stem from improved blood flow to ischemic heart areas.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Patients with coronary artery disease and reduced ejection fraction often experience impaired cardiac performance.
- Understanding the effects of antianginal drugs on cardiac hemodynamics and energetics is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate the impact of oral bepridil on cardiac performance, myocardial energetics, and neurohumoral effects in patients with coronary artery disease and reduced ejection fraction.
- To determine if bepridil therapy has deleterious effects on hemodynamics or left ventricular function under stress.
Main Methods:
- Seven patients with coronary artery disease and reduced ejection fraction received oral bepridil for 10-14 days.
- Cardiac performance, systemic and coronary hemodynamics, and neurohumoral markers were assessed at rest and during atrial pacing stress (control, submaximal, and maximal rates).
Main Results:
- Bepridil therapy did not alter key hemodynamic parameters such as filling pressures, systemic vascular resistance, or left ventricular stroke work index.
- Myocardial oxygen consumption, coronary sinus blood flow, and catecholamine balance remained unchanged, indicating no significant impact on myocardial energetics or sympathetic tone.
- The development of angina during pacing showed a variable response, suggesting a potential antianginal benefit not clearly linked to changes in anginal threshold.
Conclusions:
- Oral bepridil does not appear to exert deleterious effects on cardiac hemodynamics or left ventricular performance in patients with reduced ejection fraction.
- The antianginal efficacy of bepridil may be attributed to a favorable redistribution of myocardial blood flow to ischemic regions rather than direct effects on sympathetic tone or anginal threshold.
Abstract:
To assess the effects of oral bepridil therapy (10-14 days) on cardiac performance and myocardial energetics in the presence of depressed left ventricular function, systemic and coronary hemodynamic effects and neurohumoral effects were evaluated in 7 patients with coronary artery disease and reduced ejection fraction at control, submaximal, and maximal pacing rates during atrial pacing stress. After bepridil therapy, arterial, right atrial, and left ventricular filling pressures as well as systemic vascular resistance and left ventricular stroke work index did not change, suggesting no deleterious effects of bepridil on cardiac performance in patients with reduced ejection fraction. Rate-pressure product, myocardial oxygen consumption, coronary sinus blood flow, myocardial lactate extraction, and catecholamine balance remained unchanged. Development of angina during pacing showed a variable response to bepridil. We conclude that despite its potential negative inotropic effect, bepridil does not exert deleterious effects on hemodynamics or left ventricular performance. The mechanism for its beneficial antianginal effect may be due to favorable redistribution of myocardial blood flow to ischemic zones; no clear effect on anginal threshold or sympathetic tone could be demonstrated in these patients.