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Haemodynamic dose-response effects of intravenous nisoldipine in coronary artery disease
Insights
Nisoldipine, a novel calcium channel blocker, improved cardiac performance at rest and during exercise in patients with coronary artery disease. This new drug enhanced stroke volume and cardiac output, offering potential benefits for angina patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) significantly impacts cardiac function, particularly during exertion.
- Calcium channel blockers are crucial in managing CAD symptoms.
- Nisoldipine is a new dihydropyridine calcium channel blocker requiring evaluation.
Purpose of the Study:
- To assess the circulatory effects of nisoldipine in patients with CAD.
- To evaluate nisoldipine's impact on cardiac performance at rest and during exercise-induced angina.
Main Methods:
- 16 patients with confirmed CAD were studied.
- Intravenous nisoldipine administered in cumulative doses (1-8 µg/kg).
- Hemodynamic parameters (cardiac output, pulmonary artery occluded pressure, blood pressure, heart rate) measured at rest and during exercise.
Main Results:
- Nisoldipine reduced systemic vascular resistance and mean arterial pressure at rest and during exercise.
- Increased heart rate, cardiac index, and stroke volume index at rest.
- Augmented cardiac and stroke volume indices during exercise with unchanged pulmonary artery occluded pressure.
- A trend towards increased left ventricular ejection fraction at rest and during exercise.
Conclusions:
- Nisoldipine effectively improves cardiac performance in patients with severe coronary artery disease.
- The drug demonstrates beneficial hemodynamic effects both at rest and during exercise.
- Nisoldipine shows potential as a therapeutic agent for managing patients with coronary artery disease and angina.
Abstract:
The circulatory consequences of slow-calcium channel blockade with a new dihydropyridine nisoldipine were evaluated at rest and during exercise-induced angina in 16 patients with angiographically proven coronary artery disease. In 10 patients resting cardiac stroke output (thermodilution) and pulmonary artery occluded pressure were determined following four intravenous nisoldipine injections (cumulative dosage of 1, 2, 4 and 8 micrograms kg-1). The exercise effects of nisoldipine were evaluated by comparing the effects of the 8 micrograms kg-1 cumulative dosage with a control exercise period at the same workload. At rest nisoldipine reduced systemic vascular resistance and mean arterial pressure, and increased heart rate, cardiac and stroke volume indices. During 4 min supine-bicycle exercise nisoldipine reduced systemic mean arterial pressure and vascular resistance; this resulted in augmented cardiac and stroke volume indices at an unchanged pulmonary artery occluded pressure. In six additional patients rest and exercise ejection fractions were measured using a nonimaging nuclear probe. Nisoldipine (4 micrograms kg-1) resulted in a small trend to increase left ventricular rest and exercise ejection fraction. These data demonstrated improved rest and exercise cardiac performance following nisoldipine in patients with severe coronary artery disease.