Hemodynamic effects of PN 200-110 (isradipine) in congestive heart failure

PN 200-110 (isradipine), a dihydropyridine derivative, is a newly available calcium antagonist with potent vasodilatory properties. To determine if PN 200-110 might benefit patients with congestive heart failure (CHF), its acute hemodynamic effects were evaluated in a group of 12 patients with severe CHF. Measurements of cardiac performance were obtained after oral administration of placebo and 15 mg of PN 200-110. Placebo resulted in no significant changes in any of the variables. PN 200-110 decreased mean arterial pressure from 94 +/- 14 (mean +/- standard deviation) to 77 +/- 7 mm Hg (p less than 0.001) and increased both cardiac index from 2.1 +/- 0.4 to 2.8 +/- 0.6 liters/m2 (p less than 0.01) and stroke volume index from 26 +/- 7 to 36 +/- 10 ml/m2 (p less than 0.001). Systemic vascular resistance was reduced from 1,726 +/- 563 to 1,099 +/- 370 dynes s cm-5 (p less than 0.01). Neither heart rate nor pulmonary artery wedge pressure changed significantly. Of the 7 patients discharged receiving PN 200-110, 6 improved clinically and there was evidence of a substantial reduction in cardiothoracic ratio on chest x-ray in some patients. No serious side effects were encountered. Vasodilation with PN 200-110 can improve cardiac performance acutely in patients with CHF. Although this clinical experience is encouraging, carefully performed long-term trials must be done to determine the value of this drug in the management of patients with CHF.