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[Acute hemodynamic effects of nicardipine in patients with chronic congestive heart failure]
Insights
Nicardipine effectively improved hemodynamics in chronic heart failure (CHF) patients by reducing vascular resistance and increasing cardiac index. Responders showed significant improvements, unlike non-responders with severe hemodynamic compromise.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic heart failure (CHF) significantly impacts patient hemodynamics.
- NYHA class III and IV patients represent a severe stage of CHF.
Purpose of the Study:
- To evaluate the hemodynamic effects of nicardipine in severe CHF patients.
- To identify predictors of response to nicardipine treatment.
Main Methods:
- Hemodynamic monitoring in 13 CHF patients (NYHA class III/IV) before and after IV nicardipine (10 mg).
- Assessment of parameters including mean arterial pressure, systemic vascular resistance (SVR), total pulmonary resistance (TPR), cardiac index (CI), and pulmonary wedge pressure (PWP).
Main Results:
- Nicardipine significantly decreased mean arterial pressure, SVR, and TPR.
- Cardiac index (CI) increased in most patients (responders), but not in those with clinical worsening (non-responders).
- Non-responders had less reduction in TPR and SVR, and baseline TPR/PWP values differed between responders and non-responders.
Conclusions:
- Nicardipine demonstrates efficacy in improving hemodynamics for CHF patients without severe hemodynamic failure.
- Baseline TPR and PWP may predict response to nicardipine in CHF management.
Abstract:
We evaluated haemodynamic parameters in 13 patients suffering from chronic heart failure (CHF) in III and IV NYHA class. They were 10 males and 3 females, average age 57 +/- 11 years. Haemodynamic monitoring was made at basal condition and for 40 min after the administration of nicardipine (10 mg iv). We observed that mean arterial pressure and systemic vascular resistances (SVR) showed an important decrease (respectively -10.8%, p less than 0.001 and -22%, p less than 0.001); total pulmonary resistances (TPR) also decreased (-16.6%, p less than 0.001), while mean pulmonary pressure did not show significant reduction. Cardiac index increased with the highest value at the fifteenth minute (-11.7%, p less than 0.01). Pulmonary wedge pressure (PWP) did not show statistic variations, and heart rate too. Cardiac index (CI) did not rise in 3 patients with clinical worsening during the monitoring (patients non responders) (CI increase was less than 15%); while in 10 patients CI increased more than 15% (patients responders). Patients non responders did not show any decrease of TPR and only a transitory reduction of SVR; patients responders showed an important decrease of TPR, SVR, PWP. We observed that at baseline, the difference between the 2 groups was based on the value of TPR and PWP. We conclude that nicardipine is an efficient drug in patients affected by CHF without severe hemodynamic failure.