Noninvasive assessment of acute effects of nifedipine on rest and exercise hemodynamics and cardiac function in patients with aortic regurgitation

The acute effects of nifedipine (20 mg sublingually) on hemodynamics and cardiac function were studied at rest and during supine bicycle exercise in 20 patients with aortic regurgitation. At rest, heart rate increased by 13%, systemic vascular resistance decreased by 34% and regurgitant index decreased by 17%. The change in systemic vascular resistance was related to its initial rest level (r = 0.82, p less than 0.001) and to the changes in forward cardiac output (r = 0.58, p less than 0.01) and regurgitant index (r = 0.60, p less than 0.01). Left ventricular end-diastolic and end-systolic volumes, stroke volume and ejection fraction were unchanged, whereas right ventricular ejection fraction increased. During exercise, nifedipine administration further increased heart rate by 8% and decreased systemic vascular resistance by 19%. Both forward stroke volume and forward cardiac output increased, but total left ventricular stroke volume was unchanged, resulting in a significant decrease in regurgitant index. Although left ventricular end-diastolic volume was slightly decreased, end-systolic volume did not increase; thus, ejection fraction was higher than that during control exercise (p less than 0.01). Right ventricular ejection fraction increased further. In aortic regurgitation, the acute administration of nifedipine improved cardiac performance and reduced regurgitation at rest and during exercise as a result of afterload reduction and increased heart rate. Whether these beneficial effects will occur during long-term therapy requires further investigation.

This article has been cited by other articles:

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				A. Evangelista, P. Tornos, A. Sambola, G. Permanyer-Miralda, and J. Soler-Soler Long-term vasodilator therapy in patients with severe aortic regurgitation. N. Engl. J. Med., September 29, 2005; 353(13): 1342 - 1349. [Abstract] [Full Text] [PDF]

				W. H. Devlin, J. Petrusha, K. Briesmiester, D. Montgomery, and M. R. Starling Impact of Vascular Adaptation to Chronic Aortic Regurgitation on Left Ventricular Performance Circulation, March 2, 1999; 99(8): 1027 - 1033. [Abstract] [Full Text] [PDF]

				T. Suzuki, T. Kanda, H. Nagaoka, S. Kubota, T. Iizuka, R. Nagai, I. Kobayashi, and T. Suzuki Predictive Value of Left Ventricular Response to Exercise in Patients with Dilated Cardiomyopathy: Assessment by Radionuclide Ventriculography Angiology, June 1, 1997; 48(6): 497 - 502. [Abstract] [PDF]