Effect of calcium antagonists on cardiac performance in patients with dilatative cardiomyopathy evaluated by noninvasive methods

Abstract

Summary: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 AVLMyocard-Check (Q-S,, 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 (-36, resp. -15%) and increased after nifedipin (+14%, resp. +25%) and after

Diltiazem treatment for the management of ischaemia in patients with poor left ventricular function: safety of long term administration.

“…Maurer et al reported radionuclide ventriculographic data on six patients with dilated cardiomyopathy given an intravenous bolus of diltiazem (200 jig/kg) followed by a continuous infusion (20 jig/kg/min). 9 The left ventricular ejection fraction at rest was 0-32 (0-16) off and 0 35 (0-19) on diltiazem. Walsh et al used a similar intravenous protocol followed by a one day oral dose and reported the haemodynamic findings after invasive studies in eight patients with a mean baseline contrast ventriculographic ejection fraction of 0-24 (range 0 11-032).10 Intravenous diltiazem increased the mean stroke volume index of the group by 50%, reduced systemic vascular resistance.by 34%, and reduced pulmonary artery wedge pressure by 34% without altering the maximal first derivative of left ventricular pressure (dP/dtmax).…”