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The effect of oral diltiazem on left ventricular performance in postinfarction patients
P A Boström1, B Lilja, B W Johansson
1Department of Medicine, Malmö General Hospital, Lund University, Sweden.
Insights
Diltiazem improved left ventricular function in postinfarction patients by enhancing contraction synergy and ejection fraction. This cardiac benefit may contribute to improved patient prognosis after myocardial infarction.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Post-myocardial infarction (MI) patients often experience impaired left ventricular function.
- Left ventricular dysfunction is a key predictor of adverse outcomes after MI.
Purpose of the Study:
- To assess the impact of diltiazem on left ventricular (LV) function in patients recovering from myocardial infarction.
- To investigate if diltiazem therapy improves cardiac contractility and ejection fraction post-MI.
Main Methods:
- A study involving twelve post-MI patients without resting cardiac decompensation.
- Diltiazem administered orally, starting with a single 120 mg dose, followed by 60 mg three times daily for two weeks.
- Isotope angiocardiography using technetium-99m at rest to measure LV function, including phase deviation and ejection fraction.
Main Results:
- Diltiazem treatment significantly improved left ventricular function.
- Observed were increased synergy of contraction (decreased phase deviation, p < 0.01) and enhanced ejection fraction (p < 0.05).
- Improvements were noted after both acute and continuous diltiazem administration.
Conclusions:
- Diltiazem effectively improves left ventricular function in post-MI patients.
- The beneficial effects may be partly attributed to a reduced pressure-rate product.
- Improved LV function with diltiazem may underlie its positive impact on post-MI prognosis.
Abstract:
The purpose of the present study was to evaluate the effect of diltiazem on the left ventricular function in postinfarction patients. Twelve patients without cardiac decompensation at rest began diltiazem therapy beginning 3 months after an acute myocardial Q-wave infarction. Oral diltiazem was administered on the first day in a single dose (120 mg) and the following 2 weeks in a 60 mg three times a day (tid) regimen. The therapeutic effect was studied by isotope angiocardiography at rest using equilibrium measurements with technetium-99m. Acute as well as continuous treatment improved left ventricular function in terms of increased synergy of the contraction (decreased phase deviation from a median of 20.0 degrees to median of 12.4 degrees and 13.0 degrees, respectively, p less than 0.01) and increased ejection fraction from a median of 46% to a median of 50% and 51%, respectively, p less than 0.05. It is suggested that the improvement of left ventricular function may be due in part to decreased pressure rate product. This improved left ventricular function during diltiazem treatment may explain the improved prognosis induced by diltiazem in postinfarction patients.