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Effects of diltiazem on postextrasystolic potentiation in coronary heart disease patients
M Di Donato1, M Maioli, N Marchionni
1Cardiology Unit, University of Florence, Italy.
European Heart Journal
|July 1, 1990
Summary
Diltiazem (D) has a mild negative inotropic effect on the left ventricle (LV) in coronary artery disease patients. However, it maintains postextrasystolic potentiation (PESP) by improving LV loading conditions.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) impacts left ventricular (LV) function.
- Postextrasystolic potentiation (PESP) is a phenomenon reflecting myocardial contractility.
- Calcium antagonists like diltiazem (D) are used in cardiovascular medicine.
Purpose of the Study:
- To investigate the effects of diltiazem (D) on left ventricular (LV) response to postextrasystolic potentiation (PESP) in CAD patients.
- To analyze hemodynamic and LV function parameters under diltiazem.
- To assess regional wall kinetics before and after diltiazem administration.
Main Methods:
- LV angiography was performed in 15 CAD patients.
- Diltiazem (D) was administered (0.25 mg/kg bolus, 1.4 µg/kg/min infusion).
- Programmed atrial stimulation was used to induce PESP, with specific S1-S1, S1-S2, and S2-S3 intervals.
Main Results:
- Diltiazem (D) showed a mild negative inotropic effect, reducing postextrasystolic end-systolic pressure/volume and dP/dtmax.
- The increase in ejection fraction (EF) during PESP was preserved.
- Diltiazem (D) reduced afterload and increased preload (higher EDVI), improving LV filling rate.
Conclusions:
- Diltiazem (D) preserves PESP-induced EF increase by favorably altering LV loading conditions.
- The drug's effects on preload may be due to increased left atrial pressure or improved LV relaxation.
- Diltiazem (D) does not alter overall regional wall kinetics but may be influenced by baseline contraction severity.
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