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Coronary vasodilatory action of elgodipine in coronary artery disease
H Suryapranata1, A Maas, D C MacLeod
1Thoraxcenter, Rotterdam, The Netherlands.
Insights
Elgodipine, a new calcium antagonist, significantly widens coronary arteries and improves blood flow in patients with coronary artery disease. This novel drug demonstrates vasodilatory effects without negatively impacting heart rate or myocardial oxygen demand.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
- Novel therapeutic agents are needed to improve coronary blood flow and manage CAD.
- Dihydropyridine calcium antagonists are established vasodilators, but new generations offer potential improvements.
Purpose of the Study:
- To evaluate the hemodynamic and coronary artery effects of intravenous elgodipine, a novel second-generation dihydropyridine calcium antagonist.
- To assess the impact of elgodipine on coronary artery diameter and blood flow in patients with suspected CAD.
- To determine if elgodipine affects myocardial oxygen consumption or contractile function.
Main Methods:
- A prospective study involving 15 patients undergoing cardiac catheterization for suspected CAD.
- Intravenous administration of elgodipine at 1.5 micrograms/kg/min for 10 minutes.
- Hemodynamic parameters (blood pressure, heart rate, LVEDP) were monitored.
- Coronary artery diameter and stenosis were quantitatively assessed using computer-assisted coronary angiography.
- Coronary sinus and great cardiac vein flow, and resistance were measured.
Main Results:
- Elgodipine significantly decreased systemic blood pressure but did not alter heart rate or LVEDP.
- A significant increase in coronary artery diameter (mean increase of 9.3%) and obstruction diameter was observed.
- Coronary sinus and great cardiac vein flow increased by 15% and 26%, respectively.
- Coronary vascular resistance decreased significantly, while myocardial oxygen consumption remained unchanged.
- Contractile responses showed a slight but significant increase in maximum velocity and shortened time constant of early relaxation.
Conclusions:
- Intravenous elgodipine induces significant vasodilation in both coronary resistance and epicardial conductance vessels.
- Elgodipine effectively increases coronary blood flow and artery diameter in patients with suspected CAD.
- The drug demonstrates a favorable safety profile, with no adverse effects on heart rate, myocardial oxygen demand, or contractile function at the tested dose.
Abstract:
The effects of intravenous elgodipine, a new second-generation dihydropyridine calcium antagonist, on hemodynamics and coronary artery diameter were investigated in 15 patients undergoing cardiac catheterization for suspected coronary artery disease. Despite a significant decrease in systemic blood pressure, elgodipine infused at a rate of 1.5 micrograms/kg/min over a period of 10 minutes did not affect heart rate and left ventricular end-diastolic pressure. The contractile responses during isovolumic contraction showed a slight but significant increase in maximum velocity (56 +/- 10 to 60 +/- 10 seconds-1; p less than 0.005), whereas the time constant of early relaxation was shortened from 49 +/- 11 to 44 +/- 9 ms (p less than 0.05). Coronary sinus and great cardiac vein flow increased significantly by 15 and 26%, respectively. As mean aortic pressure decreased, a significant decrease in coronary sinus (-27%) and great cardiac vein (-28%) resistance was observed, while the calculated myocardial oxygen consumption remained unchanged. In all, 69 coronary segments (including 13 stenotic segments) were analyzed quantitatively using computer-assisted quantitative coronary angiography. A significant increase in mean coronary artery diameter (2.27 +/- 0.53 to 2.48 +/- 0.53 mm; p less than 0.000001), as well as in obstruction diameter, (1.08 +/- 0.29 to 1.36 +/- 0.32 mm; p less than 0.02), was observed. The results demonstrate that elgodipine, in the route and dose described, induces significant vasodilatation of both coronary resistance and epicardial conductance vessels, without adverse effects on heart rate, myocardial oxygen demand and contractile indexes.