Beneficial effects of sublingual nifedipine in patients with ischemic heart disease and depressed left ventricular function.

Abstract

The effects of sublingual nifedipine, a calcium channel beta-blocking drug, were assessed in eleven patients with coronary artery disease and depressed left ventricular function. All patients had a previous documented myocardial infarction. Specifically examined were the effects of a 20 mg dose on left ventricular ejection fraction as assessed through gated pool nuclear imaging. All patients had their anti-anginal drugs stopped forty-eight hours prior to inclusion in the study. Baseline resting determinations included a mean heart rate of 80 beats/minute, mean arterial pressure of 97 mmHg and an ejection fraction of 36 percent. Thirty minutes following a 20 mg sublingual dose, these parameters were reassessed. Mean heart rate increased to 89 beats/minute, p<0.02; mean arterial pressure decreased to 78 mmHg, p<.002; while ejection fraction increased to 48± 17 percent, p<.001. No adverse reactions were reported. These results demonstrate that nifedipine will acutely improve de creased left ventricular function in patients with coronary artery disease. While calcium blockers can significantly depress myocardial contractility, nifedipine's ability to decrease mean arterial pressure and peripheral vascular resistance reduces afterload, improves myocardial performance which offsets any negative effects on contractility that may exist. This drug promises to be especially useful in patients with coronary artery disease and severely de pressed left ventricular function where agents such as beta-blockers are con traindicated.