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Effects on hemodynamics and left ventricular ejection fraction of intravenous be pridil for impaired left ventricular function secondary to coronary artery disease

1987; Elsevier BV; Volume: 60; Issue: 1 Linguagem: Inglês

10.1016/0002-9149(87)90982-9

1879-1913

Martin A. Josephson, Tara Mody, Kristine Coyle, Bramah N. Singh,

Pesticide Residue Analysis and Safety

To define the hemodynamic effects of bepridil in patients with depressed left ventricular (LV) function, 22 patients with an LV ejection fraction (EF) of 0.45 or less were studied before, and after 2 mg/kg (n = 11) and 4 mg/kg (n = 11) of intravenous bepridil. Maximal hemodynamic effects were evident between between 15 and 30 minutes after drug infusion. After 2 mg/kg, heart rate decreased 9 % (p <0.01), cardiac index 17% (p <0.01), LV dP/dt max 16% (p <0.01), stroke work index 14% (p <0.01) and mean aortic pressure 8 % (difference not significant). Right atriai pressure increased 8 % (not significant), pulmonary arterial wedge pressure 24% (p <0.01) and systemic vascular resistance 17% (p <0.01). After administering 4 mg/kg of bepridil the changes in heart rate, cardiac index, right atrial pressure, LV dP/dt max, mean aortic pressure and systemic vascular resistance were almost identical to those after the smaller dose. The larger dose produced a 40% (p <0.01) increase in pulmonary arterial wedge pressure and a 22% decrease in stroke work index (p <0.01), but only the change in wedge pressure was significantly greater (p <0.01) than that produced by the lower dose. Radionuclide-determined LVEF decreased 6 % (p <0.05), from 0.33 ± 0.14 after 2 mg/kg and 11 (p <0.05) from 0.27 ± 0.11 after 4 mg/kg of bepridil. The data indicate that bepridil exerts significant negative inotropic'and chronotropic effects in patients with impaired LV function.