Acute Effects of Nifedipine on Systolic and Diastolic Ventricular Function in Patients With Chronic Obstructive Pulmonary Disease

Mols, Pierre; Huynh, Chi Hoang; Dechamps, Philippe; Naeije, Nicole; Ham, Hyeonmi

doi:10.1378/chest.103.5.1381

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Third, RV diastolic pressures were not affected. Fourth, prior studies using this catheter in supine animals and humans have not reported the presence of a systolic pressure difference between the RV and PA, [43, 44] while others have reported in post-operative patients a similar phenomenon (in that context, however, it was associated with reduced cardiac output) that was reversible by medical intervention [1, 44]. Sex and body size were associated with RVOT gradient severity.…”

Section: Discussionmentioning

confidence: 92%

Hemodynamic and metabolic characteristics associated with development of a right ventricular outflow tract pressure gradient during upright exercise

et al. 2017

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BackgroundWe recently reported a novel observation that many patients with equal resting supine right ventricular(RV) and pulmonary artery(PA) systolic pressures develop an RV outflow tract(RVOT) pressure gradient during upright exercise. The current work details the characteristics of patients who develop such an RVOT gradient.MethodsWe studied 294 patients (59.7±15.5 years-old, 49% male) referred for clinical invasive cardiopulmonary exercise testing, who did not have a resting RVOT pressure gradient defined by the simultaneously measured peak-to-peak difference between RV and PA systolic pressures.ResultsThe magnitude of RVOT gradient did not correspond to clinical or hemodynamic findings suggestive of right heart failure; rather, higher gradients were associated with favorable exercise findings. The presence of a high peak RVOT gradient (90th percentile, ≥33mmHg) was associated with male sex (70 vs. 46%, p = 0.01), younger age (43.6±17.7 vs. 61.8±13.9 years, p<0.001), lower peak right atrial pressure (5 [3–7] vs. 8 [4–12]mmHg, p<0.001), higher peak heart rate (159±19 vs. 124±26 beats per minute, p<0.001), and higher peak cardiac index (8.3±2.3 vs. 5.7±1.9 L/min/m2, p<0.001). These associations persisted when treating peak RVOT as a continuous variable and after age and sex adjustment. At peak exercise, patients with a high exercise RVOT gradient had both higher RV systolic pressure (78±11 vs. 66±17 mmHg, p<0.001) and lower PA systolic pressure (34±8 vs. 50±19 mmHg, p<0.001).ConclusionsDevelopment of a systolic RV-PA pressure gradient during upright exercise is not associated with an adverse hemodynamic exercise response and may represent a normal physiologic finding in aerobically fit young people.

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Section: Discussionmentioning

confidence: 92%

Hemodynamic and metabolic characteristics associated with development of a right ventricular outflow tract pressure gradient during upright exercise

et al. 2017

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“…23 Furthermore, some studies evaluating the effect of CCBs on RV function in patients with chronic obstructive pulmonary disease (COPD) have been performed. [24][25][26] In 13 subjects with COPD sublingual administration of nifedipine resulted in decreased RV afterload and an increased RV contractility and compliance. 24 In patients with COPD with partial or full respiratory insufficiency and reduced baseline RVEF, a single oral dose of nifedipine resulted in a partial recovery in RVEF in 63% of subjects.…”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26] In 13 subjects with COPD sublingual administration of nifedipine resulted in decreased RV afterload and an increased RV contractility and compliance. 24 In patients with COPD with partial or full respiratory insufficiency and reduced baseline RVEF, a single oral dose of nifedipine resulted in a partial recovery in RVEF in 63% of subjects. 25 Also, short-term treatment with the DHP CCB felodipine in subjects with advanced COPD leads to an increase in RVEF and a decrease in pulmonary vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

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Identifying risk factors for perioperative decline in right ventricular performance in cardiac surgery patients: a prospective observational study in a tertiary care hospital

et al. 2023

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ObjectivesImpaired right ventricular (RV) function after cardiac surgery is associated with morbidity and long-term mortality. The purpose of this study was to identify factors that play a role in the development of RV dysfunction in the perioperative cardiac surgery setting.DesignWe performed a prospective, observational, single centre study. Over a 2-year period, baseline and perioperative characteristics were recorded. For analysis, subjects were divided into three groups: patients with a ≥3% absolute increase in postoperative RV ejection fraction (RVEF) in comparison to baseline (RVEF+), patients with a ≥3% absolute decrease in RVEF (RVEF−) and patients with a <3% absolute change in RVEF (RVEF=).SettingTertiary care hospital in the Netherlands.ParticipantsWe included all cardiac surgery patients ≥18 years of age equipped with a pulmonary artery catheter and admitted to the ICU in 2015–2016. There were no exclusion criteria. A total number of 267 patients were included (65.5% men).Outcome measuresRisk factors for a perioperative decline in RV function.ResultsA reduction in RVEF was observed in 40% of patients. In multivariate analysis, patients with RVEF− were compared with patients with RVEF= (first-mentioned OR) and RVEF+ (second-mentioned OR). Preoperative use of calcium channel blocker (CCB) (OR 3.06, 95% CI 1.24 to 7.54/OR 2.73, 95% CI 1.21 to 6.16 (both p=0.015)), intraoperative fluid balance (FB) (OR 1.45, 95% CI 1.02 to 2.06 (p=0.039)/OR 1.09, 95% CI 0.80 to 1.49 (p=0.575)) and baseline RVEF (OR 1.22; 95% CI 1.14 to 1.30/OR 1.27, 95% CI 1.19 to 1.35 (both p<0.001)) were identified as independent risk factors for a decline in RVEF during surgery.ConclusionApart from the impact of the perioperative FB, preoperative use of a CCB as a risk factor for perioperative reduction in RVEF is the most prominent new finding of this study.

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Chronic Obstructive Pulmonary Disease Exacerbation

Domínguez-Cherit¹,

Nava²

2004

Sepsis

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Chronic obstructive pulmonary disease (COPO) is the only leading cause of death with a rising prevalence It is the fourth leading cause of death in the United States and accounts for approximately 500,000 hospitalizations and 110,000 deaths for exacerbations each year. Patients who are admitted to the intensive care unite (ICU) for COPO exacerbations have an in-hospital mortality of 24%.1-4 It has been estimated that by the year 2020, COPO will be fifth among the conditions that will be the most burden to society.5Morbidity and mortality due to COPO vary dramatically between industrialized countries. These variations have been attributed to different exposures to risk factors such as tobacco, atopy, occupational hazards, genetic factors, and air pollution. Outside the United States, COPO has had a similar impact on health and mortality throughout the developed and underdeveloped world, and many of the important issues surrounding COPO in the United States applyelsewhere. 6 DefinitionsThe term COPD, as recommended by the American Thoracic Society, must be applied to patients who have chronic bronchitis and/or emphysema with significant airflow limitation that does not change significantly over a period of several months of observation, thus distinguishing these patients from those with asthma. 5New definitions of acute COPO exacerbation (AECOPO) have been suggested, but the one widely accepted is generally considered as the presence of one or more of the following findings: increase in sputum purulence, increase in sputum volume, and worsening of dyspnea. Patients with COPO present acute decompensation one to three times a year, and 3% to 10% require hospitalization.1.2 Assessment of the magnitude of these three symptoms can determine the severity of an exacerbation. When all three symptoms are present, it is a type I exacerbation. If any two of the three symptoms are present, it is 101 G. Ortiz-Ruiz et al. (eds.), Sepsis

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Acute Effects of Nifedipine on Systolic and Diastolic Ventricular Function in Patients With Chronic Obstructive Pulmonary Disease

Cited by 5 publications

References 12 publications

Hemodynamic and metabolic characteristics associated with development of a right ventricular outflow tract pressure gradient during upright exercise

Hemodynamic and metabolic characteristics associated with development of a right ventricular outflow tract pressure gradient during upright exercise

Identifying risk factors for perioperative decline in right ventricular performance in cardiac surgery patients: a prospective observational study in a tertiary care hospital

Chronic Obstructive Pulmonary Disease Exacerbation

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