LEFT-VENTRICULAR DYSFUNCTION - WHICH ROLE FOR CALCIUM-ANTAGONISTS

Left ventricular dysfunction is the most common cause of congestive he art failure. Thus, treating or preventing left ventricular dysfunction represents an important therapeutic goal. The use of calcium antagoni sts in the treatment of left ventricular dysfunction or congestive hea rt failure has been proposed for many years now, mainly because of the ir potent vasodilatory effect. However, despite the theoretical basis, the results of studies exploring the possible use of calcium antagoni sts in this setting have not been at all encouraging. It has been sugg ested that this is because calcium antagonists have important addition al effects: they depress cardiac contractility and activate the neuroh ormonal system. The various calcium antagonists have different charact eristics and can be potentially useful in a variety of clinical condit ions. Amlodipine (a calcium antagonist with a minimal cardiodepressant effect, long half-life and minimal activity on the neurohormonal syst em) has been shown to be clinically useful in congestive heart failure of non-ischaemic origin. Calcium antagonists capable of limiting hear t rate increment are useful in limiting ischaemia-induced left ventric ular dysfunction. Verapamil exerts a potent protective effect on both microvascular damage and mechanical recovery during prolonged ischaemi a followed by reperfusion. Lastly, nisoldipine is capable of ameliorat ing left ventricular function in patients with left ventricular diasto lic dysfunction and has, therefore, potential in the treatment of cong estive heart failure of left ventricular diastolic dysfunction origin. Thus, calcium antagonists may have a role in the treatment of left ve ntricular dysfunction provided that patient characteristics, the under lying mechanisms of the left ventricular dysfunction and the various c alcium antagonist characteristics are well understood and carefully co nsidered.