Spectrum of acute hemodynamic effects of nifedipine in severe congestive heart failure

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      The acute hemodynamic effects of 20 to 50 mg of orally administered nifedipine were evaluated in 31 patients with severe chronic congestive heart failure (CHF) and the results were analyzed according to the response of the cardiac index (CI). Although the group mean value of CI increased significantly after nifedipine treatment (from 2.1 ± 0.5 to 2.4 ± 0.8 liters/min/m2, p < 0.001), the individual response was variable. Twenty of the patients had 15% or greater increase in CI (group A) and 11 patients had less than a 15% increase or a decrease in CI (group B). Marked differences were also noted in the effects of nifedipine on other hemodynamic variables. Stroke volume increased 29 ± 14% in group A and decreased 11 ± 18% in group B (p < 0.001). Systemic vascular resistance decreased 34 ± 11% in group A (p < 0.001) and increased slightly, 2 ± 28%, in group B. Left ventricular (LV) stroke work index increased 11 ± 19% in group A (p < 0.001) and decreased markedly in Group B (21 ± 20%). Six group B patients had a substantial worsening (20% or more) of one or more hemodynamic measurements, including CI, stroke volume index, LV stroke work index and mean pulmonary artery wedge pressure. A comparison of control hemodynamic values at rest, LV ejection fraction, associated coronary artery disease, nifedipine dose, and concomitant diuretic therapy revealed no significant differences between the 2 groups. This study confirms, in a large group of patients with severe CHF, the variable hemodynamic effects of nifedipine therapy. Although CI improved in many patients, in some patients (35%) did not. Moreover, nifedipine therapy resulted in a significant hemodynamic deterioration in 6 patients. The response to therapy was not dose-related and could not be predicted by baseline hemodynamics, LV function, presence of associated coronary artery disease and concomitant diuretic therapy. Caution and hemodynamic monitoring are recommended if this agent is used in patients with severe chronic CHF.
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