title: Effect of calcium antagonists on cardiac performance in patients with dilatative cardiomyopathy evaluated by noninvasive methods.
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.
mesh_terms: D000328:Adult; D002118:Calcium / Q000037:antagonists & inhibitors*; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004110:Diltiazem / Q000494:pharmacology; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000494:pharmacology; D011877:Radionuclide Imaging; D011897:Random Allocation; D014665:Vasodilator Agents / Q000494:pharmacology*; D014700:Verapamil / Q000494:pharmacology
chemical_list: D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D014700:Verapamil; D004110:Diltiazem; D009543:Nifedipine; D002118:Calcium