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Effect of short and long term administration of amiodarone on ischaemia-induced left ventricular dysfunction.
Insights
Amiodarone effectively manages ischaemia-induced left ventricular dysfunction by improving oxygen use. It reduces heart rate and blood pressure without negative inotropic effects, potentially enhancing other antianginal therapies.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Ischaemia-induced left ventricular dysfunction is a significant clinical challenge.
- Existing antianginal drugs have varying haemodynamic profiles and limitations.
Purpose of the Study:
- To evaluate the short-term and long-term haemodynamic effects of amiodarone.
- To compare amiodarone's effects with glyceryl trinitrate, beta-blockers, and calcium antagonists.
- To assess amiodarone's impact on ischaemia-induced left ventricular dysfunction.
Main Methods:
- Simultaneous right heart catheterisation and radionuclide angiocardiography were performed.
- 19 patients with chronic ischaemic heart disease were studied at rest and during exercise.
- Patients received either intravenous/oral amiodarone or randomized antianginal drugs (glyceryl trinitrate, metoprolol, nifedipine).
Main Results:
- Amiodarone improved myocardial oxygen consumption during exercise.
- It reduced heart rate and systolic blood pressure without negative inotropic effects.
- These effects contrast with acute beta-adrenoceptor blockade.
Conclusions:
- Amiodarone demonstrates beneficial haemodynamic effects in ischaemic left ventricular dysfunction.
- Combination therapy with glyceryl trinitrate or nifedipine may enhance amiodarone's efficacy.
- Amiodarone offers a distinct therapeutic option for managing ischaemic heart disease.
Abstract:
To asses haemodynamic effects of short and long term amiodarone on ischaemia-induced left ventricular dysfunction and to compare them with those of glyceryl trinitrate (nitroglycerin), beta-blocking and calcium antagonist drugs, 19 patients with chronic ischaemic heart disease were studied. All patients underwent simultaneous right heart catheterisation and equilibrium radionuclide angiocardiography at rest and during symptom-limited supine bicycle exercise. After control measurements without antianginal therapy, 10 patients received 7.5 mg/kg amiodarone intravenously over 5 minutes (short term study) followed by oral administration of amiodarone for 3 weeks (long term study). The remaining 9 patients were studied following the randomised administration of glyceryl trinitrate (0.8 mg sublingually), metoprolol (0.15 mg/kg intravenously) and nifedipine (5 ng/kg/min). During exercise known to provoke angina pectoris without therapy (control study), amiodarone improved myocardial oxygen consumption by reducing heart rate and systolic blood pressure without the negative inotropic effects seen after acute beta-adrenoceptor blockade. Comparisons with the haemodynamic profiles of other antianginal drugs suggest that amiodarone may be most effective when combined with glyceryl trinitrate or nifedipine for the treatment of ischaemic left ventricular dysfunction.