Acute and chronic effects of nicardipine on systolic and diastolic left ventricular performance in patients with heart failure: A pilot study

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Abstract
Nicardipine is a new calcium ion antagonist with vasodilating properties which has been shown to be effective in the treatment of hypertension and angina. We have studied its effect on systolic and diastolic left ventricular function in patients with mild to moderate degrees of congestive heart failure. Ten male patients with New York Heart Association Class II and III heart failure underwent acute treatment with an intravenous infusion of nicardipine (10 mg over 10 minutes). A nuclear probe was used to monitor left ventricular ejection fraction, peak filling rate, and relative cardiac output. Blood pressure and heart rate were also measured. The blood pressure (mean±SD) fell from 133±26/86±11 mmHg to 103±22/69±13; the heart rate rose from 67±9 beats/min to 85±10; left ventricular ejection fraction from 31±7 to 38±6%; relative cardiac output from 24±9 to 41±11; peak filling rate from 1.18±0.4 end‐diastolic volume per second to 1.82±0.4 (p<0.001 in all cases) at the end of infusion. After 4 weeks of chronic treatment in eight patients (20 mg to be taken three times daily (tds) in one and 40 mg tds in 7), the blood pressure and heart rate had returned to baseline values but the improvements in left ventricular ejection fraction, relative cardiac output, and peak filling rate were sustained; this was associated with functional improvement in all 8 patients. This preliminary study suggests that nicardipine has a potent vasodilator effect and produces significant objective improvement in left ventricular function, without producing any negative ionotropic effects. Further studies are required to confirm these effects in a wider range of patients with heart failure.