Acute hemodynamic effects of nifedipine in patients with ischemic heart disease

We studied the acute hemodynamic effects of nifedipine in 20 patients with angiographically proved coronary artery disease. Eight patients were studied during exercise-induced pain. There was an expected abnormal increase in pulmonary wedge pressure (28 +/- 8 mm Hg, mean +/- SD) accompanying chest pain (onset 179 seconds, duration 334 seconds) and ST-segment depression (2.2 +/- 0.9 mm) on the ECG. Pacing stress was used in six patients and increased left ventricular (LV) end-diastolic pressure (from 16 +/- 6 to 26 +/- 6 mm Hg), volumes (end-diastolic 63 +/- 20 to 81 +/- 22 ml/m2, end-systolic 26 +/- 15 to 47 +/- 16 ml/m2) and impaired ejection fraction (0.60 +/- 0.15 to 0.44 +/- 0.11) compared with control values. In both groups, nifedipine, 20 mg sublingually, significantly shortened duration of pain, reduced ST depression on the ECG (p less than 0.001) and reversed all hemodynamic abnormalities. In another group of six patients with recent (less than 4 months) acute myocardial infarction and moderately severe LV dysfunction at rest, nifedipine reduced LV end-diastolic pressure from 21 +/- 6 to 12 +/- 5 mm Hg and volumes (end-diastolic from 109 +/- 35 to 95 +/- 32 ml/m2, end-systolic from 41 +/- 15 to 31 +/- 7 ml/m2), while the ejection fraction improved significantly, from 0.43 +/- 0.08 to 0.58 +/- 0.11. Thus, the antianginal effect of nifedipine is associated with improved systolic emptying and reduced diastolic filling of the heart. Nifedipine appears to have no discernible adverse effects in patients with depressed LV function.