Effects of long-term treatment with calcium antagonists on left ventricular diastolic function in stable angina and heart failure.
The appearance of impaired left ventricular diastolic function in chronic ischemic heart disease often precedes systolic dysfunction. Myocardial ischemia and increased calcium loading have been implicated in the genesis of increased left ventricular stiffness. We have assessed the effects of long-term therapy with different classes of calcium channel-blocking drugs on left ventricular peak filling rate in patients with chronic stable angina and congestive heart failure secondary to ischemic heart disease. Therapeutic effects of nicardipine (30 mg t.i.d.), nisoldipine (10 mg b.i.d.), and verapamil (120 mg t.i.d.) (4 weeks) have been assessed on radionuclide left ventricular diastolic filling parameters in patients with chronic stable angina using placebo-controlled studies. All three drugs significantly improved exercise capacity as compared with placebo. Verapamil produced significant improvements in peak filling rate (p less than 0.005), time to peak filling rate (p less than 0.01), and first one-third filling fraction (p less than 0.005), whereas nicardipine only improved peak filling rate (p less than 0.005); neither drug altered the mean ejection fraction (n = 20). Nisoldipine did not significantly alter diastolic filling parameters or ejection fraction (n = 10). Nisoldipine and digoxin were also assessed in congestive heart failure (New York Heart Association [NYHA] classes II and III) associated with ischemic heart disease (n = 26) (open parallel design). Neither produced significant alterations in peak filling rate and ejection fraction after 3 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Cardiology, Northwick Park Hospital, Middlesex, England.
A
A
Lahiri
E A
EA
Rodrigues
G P
GP
Carboni
E B
EB
Raftery
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002302:Cardiac Output / Q000187:drug effects; D004077:Digoxin / Q000627:therapeutic use; D005080:Exercise Test; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D015635:Radionuclide Ventriculography; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors
D002121:Calcium Channel Blockers; D004077:Digoxin