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Effects of long-term treatment with calcium antagonists on left ventricular diastolic function in stable angina and
A Lahiri1, E A Rodrigues, G P Carboni
1Department of Cardiology, Northwick Park Hospital, Middlesex, England.
Insights
Verapamil and nicardipine improved diastolic function in chronic ischemic heart disease patients, with verapamil showing broader benefits. Neither drug significantly altered ejection fraction or improved diastolic function in heart failure patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Impaired left ventricular diastolic function often precedes systolic dysfunction in chronic ischemic heart disease.
- Myocardial ischemia and calcium overload contribute to increased left ventricular stiffness.
Purpose of the Study:
- To assess the long-term effects of nicardipine, nisoldipine, and verapamil on left ventricular diastolic function in patients with chronic stable angina and heart failure due to ischemic heart disease.
Main Methods:
- Placebo-controlled studies evaluated nicardipine, nisoldipine, and verapamil in patients with chronic stable angina.
- Radionuclide left ventricular diastolic filling parameters and ejection fraction were assessed.
- Nisoldipine and digoxin were studied in heart failure patients (NYHA classes II-III) with ischemic heart disease.
Main Results:
- All three calcium channel blockers improved exercise capacity compared to placebo.
- Verapamil significantly improved peak filling rate, time to peak filling rate, and first one-third filling fraction.
- Nicardipine improved peak filling rate, but neither verapamil nor nicardipine altered ejection fraction.
- Nisoldipine did not significantly alter diastolic filling parameters or ejection fraction in angina patients.
- Nisoldipine and digoxin showed no significant improvements in diastolic function or ejection fraction in heart failure patients.
Conclusions:
- Verapamil demonstrates significant benefits for left ventricular diastolic function in chronic ischemic heart disease.
- Nicardipine offers some improvement in diastolic function, while nisoldipine shows limited efficacy.
- Calcium channel blockers may not significantly improve diastolic function or ejection fraction in patients with ischemic heart failure.
Abstract:
The appearance of impaired left ventricular diastolic function in chronic ischemic heart disease often precedes systolic dysfunction. Myocardial ischemia and increased calcium loading have been implicated in the genesis of increased left ventricular stiffness. We have assessed the effects of long-term therapy with different classes of calcium channel-blocking drugs on left ventricular peak filling rate in patients with chronic stable angina and congestive heart failure secondary to ischemic heart disease. Therapeutic effects of nicardipine (30 mg t.i.d.), nisoldipine (10 mg b.i.d.), and verapamil (120 mg t.i.d.) (4 weeks) have been assessed on radionuclide left ventricular diastolic filling parameters in patients with chronic stable angina using placebo-controlled studies. All three drugs significantly improved exercise capacity as compared with placebo. Verapamil produced significant improvements in peak filling rate (p less than 0.005), time to peak filling rate (p less than 0.01), and first one-third filling fraction (p less than 0.005), whereas nicardipine only improved peak filling rate (p less than 0.005); neither drug altered the mean ejection fraction (n = 20). Nisoldipine did not significantly alter diastolic filling parameters or ejection fraction (n = 10). Nisoldipine and digoxin were also assessed in congestive heart failure (New York Heart Association [NYHA] classes II and III) associated with ischemic heart disease (n = 26) (open parallel design). Neither produced significant alterations in peak filling rate and ejection fraction after 3 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)