Haemodynamic effects of nifedipine in heart failure.

Abstract

Nifedipine, a Ca antagonist with strong vasodilatating effects, was successfully used in the treatment of angina pectoris. To investigate its use as a vasodilator in patients with congestive heart failure, nifedipine 20 mg was administered sublingually to 11 patients with chronic heart failure. The clinical diagnosis was congestive cardiomyopathy in 10 and severe mitral regurgitation in 1 patient. All patients were studied hemodynamically and in 10 of them an angiographic study was also performed. Nifedipine lowered mean systemic arterial pressure (from 95.0 .+-. 5.3 to 75.2 .+-. 3.6 mmHg), mean pulmonary arterial pressure (from 37.9 .+-. 3.1 to 28.0 .+-. 2.4 mmHg), mean pulmonary capillary wedge pressure (from 25.2 .+-. 2.0 to 16.7 .+-. 1.7 mmHg), left ventricular end-diastolic pressure (from 22.6 .+-. 1.8 to 14.2 .+-. 1.7 mmHg) and systemic vascular resistance (from 1967 .+-. 247 to 1108 .+-. 146 dynes s cm-5). Simultaneously all indices of left ventricular performance improved: cardiac index rose from 2.12 .+-. 0.11 to 3.11 .+-. 0.30 l/m2 per min, ejection fraction increased from 0.26 .+-. 0.02 to 0.41 .+-. 0.05% and stroke volume index rose from 32.2 .+-. 1.9 to 46.8 .+-. 3.4 ml/m2. Left ventricular end-diastolic volume index and end-systolic volume index diminished (from 137.2 .+-. 14.0 to 128.1 .+-. 14.3 ml/m2 and from 104.9 .+-. 13.6 to 81.3 .+-. 14.7 ml/m2, respectively). No significant changes in heart rate were noted; a slight general improvement in left ventricular wall motion was seen. In patients with congestive heart failure there were no negative inotropic effects but an improvement in left ventricular performance in all patients, caused by a decrease in afterload secondary to the strong vasodilatating effect of the drug. Further studies should document the possibility of nifedipine being used as an alternative to other afterload reducing agents in the chronic treatment of heart failure.