Acute and chronic effects of nicardipine on systolic and diastolic left ventricular performance in patients with heart failure: A pilot study

Abstract

Summary:Nicardipine is a new calcium ion antagonist with vasodilating properties which has been shown to be effective in the treatment of hypertension and angina. We have studied its effect on systolic and diastolic left ventricular function in patients with mild to moderate degrees of congestive heart failure. Ten male patients with New York Heart Association Class I1 and I11 heart failure underwent acute treatment with an intravenous infusion of nicardipine (10 mg over 10 minutes). A nuclear probe was used to monitor left ventricular ejection fraction, peak filling rate, and relative cardiac output. Blood pressure and heart rate were also measured. The blood pressure (meanfSD) fell from 133f26/86f11 mmHg to 103 f22/69 k 13; the heart rate rose from 67 f 9 beatslmin to 85 f 10; left ventricular ejection fraction from 31 f 7 to 38f6%; relative cardiac output from 24f9 to 41f11; peak filling rate from 1.18f0.4 end-diastolic volume per second to 1.82f0.4 ( p~0 . 0 0 1 in all cases) at the end of infusion. After 4 weeks of chronic treatment in eight patients (20 mg to be taken three times daily (tds) in one and 40 mg tds in 7), the blood pressure and heart rate had returned to baseline values but the improvements in left ventricular ejection fraction, relative cardiac output, and peak filling rate were sustained; this was associated with functional improvement in all 8 patients. This preliminary study suggests that nicardipine has a potent vasodilator effect and produces significant objective improvement in left ventricular function, without producing any negative ionotropic effects. Further studies are required to confirm these effects in a wider range of patients with heart failure.

Pulmonary edema during cardiac catheterization successfully treated with bolus administration of nicardipine

“…Unlike nifedipine, nicardipine in our case did not show a reflectory increase in heart rate consequent to the fall in systemic pressure. This favorable effect of nicardipine has already been reported in the literature in cases with severe chronic heart failure [1].…”

“…Up to now it has been used in systemic arterial hypertension and latent, slight or moderate cardiac insufficiency [1]. However, various studies carried out on patients with cardiac insufficiency show that long-term administration of this drug determines favorable results due to afterload reduction [4].…”

“…Acute and chronic pulmonary congestion in cardiomyopathy is due to the contractile deficit of the left ventricle. Administration of vasodilators is beneficial in these patients [1,2]. We report a case of acute pulmonary edema during cardiac catheterization treated with bolus administration of nicardipine.…”

Calcium Channel Blockers in Heart Failure

“…In another study, intravenous nicardipine (10 mg) resulted in acute and short-term improvement in LV performance in patients with mild-to-moderate CHF [52,53]. The same investigators [54] reported significant improvements in ejection fraction, cardiac output and peak filling rate assessed by radionuclide ventriculography acutely after intravenous nicardipine administration and after 4 weeks of long-term oral therapy (20-40 mg t.i.d.)…”

Twenty-four hour ambulatory blood pressure profile of a new, sustained-release preparation of nicardipine

“…Unlike diltiazem and verapamil, it lacks any significant action on the cardiac conducting system, an advantage in patients with such disorders. There is also evidence that it lacks the negative inotropic effect of other calcium antagonists and, therefore, may be a better choice in patients with left ventrieular dysfunction [3]. The drug produces side effects common to its class, namely, flushing, headache, and ankle swelling, which may limit compliance.…”