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Influence of intravenous diltiazem on left ventricular function in patients with severe coronary artery disease at
R B van Dijk1, P K Blanksma, W H van Gilst
1Department of Cardiology (Thorax Centre) University Hospital Groningen, The Netherlands.
Insights
Intravenous diltiazem improved hemodynamics in severe coronary artery disease patients. Diltiazem reduced angina during pacing, indicating improved cardiac function and tolerance.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe coronary artery disease (CAD) poses significant hemodynamic challenges.
- Understanding the effects of calcium channel blockers like diltiazem is crucial for managing CAD patients.
Purpose of the Study:
- To investigate the influence of intravenous diltiazem on hemodynamic parameters and left ventricular (LV) function in severe CAD patients.
- To assess the efficacy of diltiazem in mitigating symptoms during atrial pacing.
Main Methods:
- Hemodynamic and LV function indices were measured in 14 severe CAD patients.
- Measurements were taken at rest and during atrial pacing, before and after diltiazem infusion.
- Tip manometer catheter and nuclear probe were used for pressure and volume assessments.
Main Results:
- Diltiazem increased LV end-diastolic volume at rest.
- During atrial pacing, diltiazem significantly reduced the incidence of angina pectoris.
- Diltiazem improved several hemodynamic parameters during pacing, including reduced pulmonary wedge and LV end-diastolic pressures.
Conclusions:
- Intravenous diltiazem demonstrates beneficial effects on hemodynamics and LV function in severe CAD.
- Diltiazem effectively reduces myocardial oxygen demand and improves exercise tolerance in these patients.
Abstract:
The influence of intravenous diltiazem on hemodynamics and left ventricular function indices was studied in 14 patients with severe coronary artery disease at rest and during atrial pacing. We used a tip manometer catheter for recording left ventricular pressure tracings and a nuclear probe for measuring left ventricular volume changes. Infusion of diltiazem at rest resulted in an increase in left ventricular enddiastolic volume (+16%, p < 0.0001); all other parameters did not differ significantly from baseline values. Angina pectoris occurred in all patients during atrial pacing before diltiazem infusion (ContrP); during pacing after diltiazem infusion (DiltP) only four patients became symptomatic (at the same pacing rates). Other differences between the two pacing studied and their baseline measurement were mean arterial pressure (ContrP: +13%, p < 0.001; DiltP: +11% p < 0.001), pulmonary wedge pressure (ContrP: +54%, p = 0.019; DiltP: NS), left ventricular enddiastolic pressure (ContrP: +40%, p < 0.005; DiltP: NS), left ventricular enddiastolic volume (ContrP: -19%, p = 0.001; DiltP: -33%, p = 0.0001), left ventricular ejection fraction (ContrP: -20%, p = 0.039; DiltP: NS), maximum rate of rise of left ventricular systolic pressure (ContrP: +22%, p = 0.001; DiltP: +20%, p = 0.03), time constant of relaxation (ContrP: +40%, p = 0.001; DiltP +8%, p = 0.047), stiffness constant of the diastolic pressure-volume relationship (ContrP: +157%, p = 0.0001; DiltP: +132%, p = 0.001), and left ventricular systolic work (ContrP: -35%, p = 0.0001; DiltP -46%, p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)