title: Sildenafil and diastolic dysfunction after acute myocardial infarction in patients with preserved ejection fraction: the Sildenafil and Diastolic Dysfunction After Acute Myocardial Infarction (SIDAMI) trial.
abstract: BACKGROUND
  Diastolic dysfunction is frequently seen after myocardial infarction and is characterized by a disproportionate increase in filling pressure during exercise to maintain stroke volume. We hypothesized that sildenafil would reduce filling pressure during exercise in patients with diastolic dysfunction after myocardial infarction.
  
  
  RESULTS
  Seventy patients with diastolic dysfunction and near normal left ventricular ejection fraction on echocardiography were randomly assigned sildenafil 40 mg thrice daily or matching placebo for 9 weeks. Before randomization and after 9 weeks of treatment patients underwent simultaneous echocardiography and right heart catheterization at rest and during exercise. Primary end point was pulmonary capillary wedge pressure, and secondary end points comprised cardiac index and pulmonary arterial pressure at rest and during exercise after 9 weeks. After 9 weeks there were no differences in pulmonary capillary wedge pressure at rest (13±4 versus 13±3 mm Hg, P=0.25) or at peak exercise (35±8 mm Hg versus 31±7 mm Hg, P=0.07). However, with treatment cardiac index increased at rest (P=0.006) and peak exercise (P=0.02) in the sildenafil group, and systemic vascular resistance index (resting, P=0.0002; peak exercise, P=0.007) and diastolic blood pressure (resting, P=0.005; peak exercise, P=0.02) were lower in the sildenafil group. Resting left ventricular end-diastolic volume index increased (P=0.001) within the sildenafil group but was unchanged in the placebo group.
  
  
  CONCLUSIONS
  Sildenafil did not decrease filling pressure at rest or during exercise in post-myocardial infarction patients with diastolic dysfunction. However, there were effects on secondary end points, which require further studies.
authors: Department of Cardiology, the Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. madsand@dadlnet.dk
authors: Mads J
authors: MJ
authors: Andersen
authors: Mads
authors: M
authors: Ersbøll
authors: Anna
authors: A
authors: Axelsson
authors: Finn
authors: F
authors: Gustafsson
authors: Christian
authors: C
authors: Hassager
authors: Lars
authors: L
authors: Køber
authors: Barry A
authors: BA
authors: Borlaug
authors: Søren
authors: S
authors: Boesgaard
authors: Lene T
authors: LT
authors: Skovgaard
authors: Jacob E
authors: JE
authors: Møller
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003971:Diastole / Q000187:drug effects* / Q000502:physiology; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D058986:Phosphodiesterase 5 Inhibitors / Q000494:pharmacology*; D010879:Piperazines / Q000494:pharmacology*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology; D011687:Purines / Q000494:pharmacology; D012146:Rest / Q000502:physiology; D000068677:Sildenafil Citrate; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D013450:Sulfones / Q000494:pharmacology*; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate