Effects of preoperative treatment with diltiazem on diastolic ventricular function after coronary artery bypass graft surgery.
OBJECTIVE
To examine whether preoperative treatment with diltiazem could ameliorate left ventricular (LV) diastolic dysfunction in patients after coronary artery bypass graft (CABG) surgery.


METHODS
Prospective, nonrandomized clinical study.


METHODS
University hospital.


METHODS
Thirty-four patients with preserved LV function undergoing elective CABG surgery.


METHODS
According to medical history, patients were divided into 2 groups: patients not receiving diltiazem (n = 17) and patients treated with once-daily oral diltiazem for at least 2 weeks (n = 17). All patients received preoperative beta-blockers.


RESULTS
After induction of anesthesia, after sternal closure, and 4 hours after cardiopulmonary bypass (CPB), mitral and pulmonary venous flow velocities were measured with pulsed Doppler. LV short-axis end-diastolic area by Doppler transesophageal echocardiography (TEE) and hemodynamic variables were obtained simultaneously at comparable pulmonary capillary wedge pressures. Postoperatively, increased peak E and A velocities were observed in patients with diltiazem and controls and returned to baseline 4 hours post-CPB in controls. Changes in these velocities did not result in a decreased E/A ratio. Peak A velocity, E/A ratio, and E wave deceleration time were significantly dependent on heart rate, not peak E velocity. End-diastolic area at comparable pulmonary capillary wedge pressure remained unchanged. In relation to diltiazem, only peak A velocity and time velocity integral of the A wave (TVI-A) at 4 hours post-CPB differed from controls.


CONCLUSIONS
Diastolic function is preserved after CABG surgery and is not altered by diltiazem in patients with preserved LV systolic function. The persistence of increased peak A velocity and TVI-A into the postoperative period suggests improved atrial systolic function with diltiazem.
van der Maaten
J M
JM
Department of Anesthesiology, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. J.M.A.A.van.der.Maaten@anest.azg.nl
de Vries
A J
AJ
Henning
R H
RH
Epema
A H
AH
van den Berg
M P
MP
Lip
H
H
D000284:Administration, Oral; D001783:Blood Flow Velocity; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003971:Diastole; D004110:Diltiazem / Q000008:administration & dosage*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D011300:Preoperative Care; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left / Q000187:drug effects*
D002121:Calcium Channel Blockers; D004110:Diltiazem