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European Heart Journal 1988 9(7):740-745;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Acute haemodynamic effects of diltiazem in patients with recent Q-wave myocardial infarction

S. GHIO, S. DE SERVI, M. FERRARIO, E. POMA, E. BRAMUCCI, L. ANGOLI and G. SPECCHIA

Divisione di Cardiologia, Policlinico S. Matteo Pavia, Italy

Received 21 August 1987; revised 6 January 1988; .

Address for Correspondence: Stefano Ghio M.D., Divisione di Cardiologia. Policlinico S Matteo, 27100 Pavia, Italy.

Abstract

The effects of diltiazem on left ventricular systolic and diastolic function were studied in 14 patients with a recent (12–20 days) Q-wave myocardial infarction. Left ventriculography with simultaneous recording of high-fidelity left ventricular pressure was performed in control conditions, and after i.v. administration of diltiazem (0.2 mg kg–1 as a bolus followed by constant infusion of 0.005 mg kg–1 min–1 lasting 8–10 min). After the administration of the drug, left ventricular systolic pressure decreased by 12.7% and mean circumferential wall stress by 14% (both P<0.01); the heart rate did not change; the ejection fraction increased by 9.6% (P<0.05) and maximum dp/dt/P by 11% (P<0.01). Quantitative segmental wall motion analysis showed that the beneficial effects of diltiazem on global left ventricular systolic function were associated with an increase in contraction in hypokinetic regions, where they were supplied by normal or diseased coronary vessels (both P<0.01). Left ventricular and-diastolic pressure decreased by 23.6% (P<0.05) and minimal diastolic pressure by 38% (P<0.05). Passive diastolic properties of the left ventricular chamber remained unaltered but isovolumic relaxation markedly improved: the T constant decreased 26% (P<0.01). Thus, in patients with a recent Q-wave myocardial infarction, the i.v. administration of diltiazem unloads the left ventricular chamber without showing depressant effects on myocardial contractility

Key Words: Diltiazem • myocardial infarction • left ventricular function.


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