ACUTE EFFECTS OF INTRAVENOUS NISOLDIPINE ON LEFT-VENTRICULAR FUNCTIONAFTER ACUTE MYOCARDIAL-INFARCTION

Nisoldipine is a calcium antagonist with potent coronary vasodilating effects in patients with chronic stable angina pectoris. In an initial study we showed that intravenous nisoldipine, given 24-72 hours after uncomplicated myocardial infarction, was a safe and feasible interven tion that had beneficial effects on global and regional myocardial fun ction. We subsequently studied the acute effects of nisoldipine in six patients within 24 hours (mean 14 +/- 4 hours) after the onset of myo cardial infarction. Nisoldipine was administered as a 4.5 mu g/kg intr avenous bolus over 3 minutes, followed by intravenous infusion of 0.2 mu g/kg over 60 minutes. Radionuclide angiography, cardiac output, and intraarterial blood pressure measurements were performed before and d uring nisoldipine. Left ventricular ejection fraction increased from 4 8.3 +/- 10.3% to 55.3 +/- 11.8% (p = 0.034) during nisoldipine infusio n. Regional wall motion score changed during nisoldipine infusion from 3.3 +/- 2.5 to 1.8 +/- 2.6 (p = 0.027). Cardiac output increased from 5.5 +/- 1.0 to 7.3 +/- 1.3 l/min (p = 0.0001). Heart rate increased f rom 78 +/- 12 to 88 +/- 11 min(-1) (p = 0.004). Mean arterial blood pr essure decreased from 92 +/- 20 to 79 +/- 13 mmHg (p = 0.038). The rat e-pressure product did not change significantly during nisoldipine inf usion. It is concluded that nisoldipine improves global and regional l eft ventricular function in patients with acute myocardial infarction within the first 24 hours.