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Calcium antagonists in patients with left ventricular dysfunction: back on the bridge?
1Department of Cardiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
Journal of Cardiac Failure
|December 1, 1996
Summary
Newer calcium antagonists offer benefits in heart failure management. Long-acting formulations improve outcomes, especially in non-ischemic heart failure, though mechanisms require further study.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Calcium antagonists provide vasodilation but can depress myocardial function.
- First-generation drugs may worsen heart failure due to myocardial depression and blood pressure changes.
- Newer slow-release and long-acting calcium antagonists aim to mitigate these adverse effects.
Purpose of the Study:
- To review the current data on calcium antagonists in cardiac disease management.
- To emphasize the role of newer slow-release and long-acting formulations.
- To assess their impact on ventricular dysfunction and heart failure outcomes.
Main Methods:
- Review of available clinical data and trial results.
- Emphasis on studies involving newer calcium antagonist formulations.
- Analysis of effects on coronary/systemic vasodilation, diastolic function, and heart failure outcomes.
Main Results:
- Nisoldipine improved diastolic function and reduced ischemia in post-MI patients.
- Felodipine showed no benefit in exercise capacity or survival for Class 2-3 heart failure.
- Amlodipine demonstrated a significant mortality reduction in non-ischemic heart failure (PRAISE study).
Conclusions:
- Long-acting calcium antagonists may improve outcomes in ventricular dysfunction when used with standard therapies.
- Amlodipine shows a specific survival benefit in non-ischemic heart failure, warranting further investigation.
- Mechanisms behind amlodipine's benefit in non-ischemic heart failure remain to be elucidated.