CARDIOPROTECTIVE EFFECTS OF DILTIAZEM INFUSION IN THE PERIOPERATIVE PERIOD

Objective: To evaluate the perioperative effects of intravenous diltia zem infusion on left ventricular functions, hemodynamics and as an ant i-ischemic and antiarrhythmic agent in patients undergoing coronary ar tery bypass grafting (CABG), Methods: A double blind. randomised study was performed on 71 patients undergoing elective CABG. Infusion of di ltiazem (0.1 mg;kg per h, n = 34) or nitroglycerin (1 mu g/kg per min, n = 37) was given for 24 h starting from onset of cardiopulmonary byp ass. Holter monitoring, electrocardiogram and serum cardiac enzymes le vels were used to diagnose myocardial ischemia, Myocardial function wa s assessed by perioperative transesophageal echocardiography. Results: The two groups did not differ with respect to preoperative and operat ive data. Diltiazem had no influence on hemodynamic parameters except for significant reduction in post operative heart rate and pulse press ure rate. Transient ischemic events (dilitiazem 10.2% versus nitroglyc erin 33.3%, P = 0.15) and transient coronary spasm (diltiazem-6.8% ver sus nitroglycerin 25.9%. P = 0.15) wre reduced in the diltiazem group as compared with the nitroglycerin group. The postoperative incidence of atrial fibrillation (diltiazem 3% versus nitroglycerin 22%, P = 0.0 3, supra ventricular tachycardia (diltiazem-3% versus nitroglycerin-22 %, P = 0.03) and average ventricular premature contraction per h (dilt iazem-40.2 +/- 10.2 versus nitroglycerin 53.8 +/- 12.3, P < 0.01) were significantly lower in the diltiazem group. Transesophageal echocardi ography showed no significant difference in left ventricular functions and better preservation of left ventricular diastolic functions in po st cardiopulmonary bypass period in diltiazem group. In addition mean deceleration time for the E wave on a 12 h post cardiopulmonary bypass period was significantly lower in the diltiazem group as compared wit h nitroglycerin (diltiazem 131 +/- 6 versus nitroglycerin 171 +/- 6, P < 0.01). Conclusion: The present study demonstrates that diltiazem in fusion provides superior anti-ischemic protection and control of supra ventricular arrhythmias as compared to nitroglycerin and does not prod uce any negative inotropic effect. as demonstrated by transesophageal echocardiography. (C) 1997 Elsevier Science B.V.