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Effect of calcium antagonists on cardiac performance in patients with dilatative cardiomyopathy evaluated by
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Calcium channel blockers verapamil, nifedipine, and diltiazem show no significant impact on myocardial performance in patients with dilated cardiomyopathy. Nifedipine and diltiazem demonstrated slight improvements, suggesting safe use in impaired cardiac function.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Dilated cardiomyopathy (DCM) affects myocardial performance.
- Calcium channel blockers (CCBs) are used for cardiovascular conditions.
- The impact of specific CCBs on impaired myocardial function requires investigation.
Purpose of the Study:
- To evaluate the effects of verapamil, nifedipine, and diltiazem on myocardial performance in patients with DCM.
- To assess the safety of these CCBs in patients with impaired cardiac function.
Main Methods:
- Single-blind, randomized study of 14 DCM patients.
- Administered equipotent doses of verapamil, nifedipine, or diltiazem.
- Assessed myocardial performance using systolic time intervals, echocardiography (M-mode), and radionuclide ventriculography.
Main Results:
- No significant changes in myocardial performance (ejection fraction, cardiac index) were observed across the three CCBs.
- Verapamil showed a trend towards decreased myocardial performance (fractional shortening, circumferential fiber shortening velocity).
- Nifedipine and diltiazem demonstrated slight improvements in myocardial performance.
Conclusions:
- Verapamil, nifedipine, and diltiazem do not significantly alter myocardial performance in DCM patients.
- Nifedipine and diltiazem may offer slight benefits, while verapamil shows a tendency towards deterioration.
- CCBs can be safely administered to patients with impaired myocardial performance.
Abstract:
We present 14 patients with dilatative cardiomyopathy, proven by hemodynamic and angiographic assessment who received in a single-blind, randomized study, equipotent doses of the three calcium blockers: verapamil (0.1 mg/kg i.v., followed by an infusion of 0.01 mg/kg/min), nifedipin (20 mg sublingually), or diltiazem (0.2 mg/kg i.v., followed by infusion of 0.02 mg/kg/min). Before and after treatment in 8 patients systolic time intervals were recorded with an AVL-Myocard-Check (Q-S2, pre-ejection period, left ventricular ejection time, and pre-ejection period/left ventricular ejection time) and end-systolic and end-diastolic diameter, fractional shortening, and circumferential fiber shortening velocity were measured by M-mode echocardiography. In another 6 patients radionuclide ventriculography was performed before and after each treatment (ejection fraction, cardiac index). PEP/LVET increased slightly after verapamil (+ 15%) and decreased after nifedipin (-5%) and diltiazem (-3%), the changes being not significant. Fractional shortening and circumferential fiber shortening velocity however, decreased after verapamil (-5%, resp. -15%) and increased after nifedipin (+ 14%, resp. + 25%) and after diltiazem (+ 23%, resp. + 16%). In the radionuclide studies ejection fraction increased after verapamil (+ 9%), nifedipin (+ 14%), and diltiazem (+ 13%), while cardiac index remained unchanged with verapamil and nifedipin and increased with diltiazem (+ 14%). In conclusion there are no significant changes in myocardial performance with the calcium blockers verapamil, nifedipin, and diltiazem. However, under verapamil there is a tendency to deterioration of myocardial performance, while it was slightly improved after nifedipin and diltiazem. Calcium antagonists may be used safely, therefore, also in patients with impaired myocardial performance.