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Effects of nifedipine on left ventricular diastolic dysfunction after myocardial infarction
1Department of Cardiology, Medical School, University of Padua, Italy.
Insights
Nifedipine improved left ventricular diastolic function in post-myocardial infarction patients with reversed filling patterns. However, it showed no benefit for those with restrictive patterns.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Left ventricular diastolic abnormalities are common after myocardial infarction.
- Nifedipine is a calcium channel blocker with potential vasodilatory effects.
Purpose of the Study:
- To evaluate the efficacy of nifedipine in improving left ventricular diastolic function in patients post-myocardial infarction.
- To differentiate the effects of nifedipine on reversed versus restrictive diastolic filling patterns.
Main Methods:
- Doppler echocardiography was used to assess left ventricular diastolic filling patterns (E and A waves, E/A ratio).
- 26 patients post-myocardial infarction were studied at rest and during handgrip, with and without nifedipine.
- Comparison was made with 20 age-matched healthy controls.
Main Results:
- Nifedipine normalized left ventricular filling in 21 patients with a reversed filling pattern, both at rest and during handgrip.
- These patients demonstrated an improved left ventricular function curve after nifedipine administration.
- No beneficial effects of nifedipine were observed in the five patients with a restrictive filling pattern.
Conclusions:
- Nifedipine effectively improves left ventricular diastolic abnormalities in post-myocardial infarction patients with reversed filling patterns.
- Nifedipine does not appear to benefit patients with restrictive left ventricular filling patterns post-myocardial infarction.
Abstract:
In order to assess the effects of nifedipine on left ventricular diastolic abnormalities, 26 patients (mean age 52 year, range 42-66) were studied 10 days after a first myocardial infarction, at rest and during handgrip by Doppler examination. The time-velocity integral for the rapid (E) and atrial (A) filling phases and the E/A ration were used; stroke volume was calculated as the aortic time-velocity integral times the cross-sectional valvular area. Twenty age-matched normal subjects constituted the controls. Twenty-one patients had a reversal of the early to late diastolic filling pattern; five patients had a restrictive pattern. Nifedipine normalized left ventricular filling in patients with a reverse pattern, both at rest and during handgrip. Moreover, these patients showed a descending left ventricular function curve by relating at rest and handgrip values of cardiac index and the E/A ratio. After nifedipine, these study patients showed an ascending left ventricular curve, similar to that of normal subjects, with an increase in cardiac index and a slight decrease in the E/R ratio. No beneficial effects were detectable in patients with a restrictive pattern of left ventricular filling.