1011-119 Effect of Nisoldipine on Hypoperfused Dyssynergic Viable Myocardium After Myocardial Infarction

Abstract

After infarction, regional dysfunction can occur in still viable myocardial regions because of the presence of baseline hypoperfusion. Recent evidence suggests that these areas may maintain a residual perfusion reserve. Aim of this study was to evaluate whether oral Nisoldipine can increase regional myocardial myocardial blood flow (MBF) in dyssynergic but viable myocardium after myocardial infarction. To this purpose, 15 patients with isolated left anterior descending coronary (LAD) stenosis were studied 1 month after first myocardial infarction. Patients underwent F18-deoxiglucose imaging, while MBF was measured, using positron emission tomography and 13-Ammonia, at baseline and following dobutamine (10 μ cg/kg/min over 5 minutes, DOB). MBF measurements were repeated 24 hours later after Nisoldipine (10 mg bid). Among atotal of 102 LAD related regions, 23 showed normal wall motion at 2D-echo and normal metabolic activity (Normal), 58 showed wall motion abnormality and preserved deoxiglucose uptake (Viable), while 21 dyssynergic regions were necrotic (Necrotic). MBF data (ml/mm/100 g) were as follows: Before Nisoldipine After Nisoldipine Basal MBF DOB MBF Basal MBF DOB MBF Normal 92 ± 23 119 ± 38 85 ± 18 121 ± 46 ° Viable 62 ± 25 † 93 ± 40 † , ° 73 ± 25 ∧ 102 ± 51 ° Necrotic 46 ± 24 † , @ 51 ± 25 † , @ 52 ± 20 † , @ 56 ± 2B † , @ † p < 0.05vs Normal @ p < 0.05vs Viable ° p < 005 vo relative Basal ∧ p < 0.05 vo Basal before Nisoldipine Necrotic areas showed the largest reduction in baseline MBF. Dyssynergic viable regions showed a reduced resting MBF, but maintained a residual perfusion reserve in response to inotropic stimulation. Thus, Nisoldipine selectively improved basal perfusion in dysynergic viable myocardium.