[Is the bradycardic effect of tedisamil at the expense of the loss of the inotropic effect? A pressure-volume analysis with the conductance (volume) catheter technique in patients with coronary artery disease].
To exclude or prove potential inotropic influences from tedisamil's bradycardiac effects, our hemodynamic evaluation in 13 patients (pat.) with coronary artery disease (CAD) included analyses of end-systolic pressure-volume relationships (ESPVR) after tedisamil, 0.3 mg/kg infusion at rest and during tachycardia induced by atrial pacing. Slope Emax [mm HG/ml] fell by 14% at rest (13 pat.) and by 10% during paced tachycardia (6/13 pat.) while loops of ESPVR tended to move rightward towards larger volumes (p > 0.05): all parameter changes indicated lack of significant inotropy loss with tedisamil. While mean heart rate decreased from 77.5 to 64.7 b/min and QTc duration increased by 14% (p < 0.05), filling pressure as well as dP/dtmin remained unchanged and vascular resistance rose by 30%. Parameters of LV-pump function (ejection fraction, stroke volume) decreased slightly (between 3 and 13%), while LV-volumes increased (end-diastolic by 6%, end-systolic by 23%). The respective parameter changes during paced tachycardia were comparable in tendency.


CONCLUSIONS
Tedisamil's bradycardic effects are selectively generated without impairing either ventricular pump function or contractility in a clinically relevant fashion. Thus, tedisamil can be used safely in CAD.
Kerckhoff-Klinik, Max-Planck-Gesellschaft, Bad Nauheim.
J
J
Thormann
V
V
Mitrovic
R
R
Strasser
H F
HF
Pitschner
H
H
Riedel
H
H
Bahavar
M
M
Schlepper
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001643:Bridged Bicyclo Compounds / Q000008:administration & dosage*; D019086:Bridged Bicyclo Compounds, Heterocyclic; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D002304:Cardiac Pacing, Artificial; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D003521:Cyclopropanes / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects* / Q000502:physiology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
D000889:Anti-Arrhythmia Agents; D001643:Bridged Bicyclo Compounds; D019086:Bridged Bicyclo Compounds, Heterocyclic; D002316:Cardiotonic Agents; D003521:Cyclopropanes; C059921:tedisamil
Wird die bradykardisierende Wirkung von Tedisamil mit Inotropie-Einbusse erkauft? Eine Druck-Volumen-Analyse mit der Conductane-(Volumen-)Kathetertechnik bei Patienten mit koronarer Gefässkrankheit.