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Nicardipine or nitroglycerin in patients with failed percutaneous coronary angioplasty: effect on myocardial diastolic function.

Author(s): Casthely PA, Bunik T, Casthely PA, Yoganathan T, Komer C, Mekhjian H Jr

Affiliation(s): Division of Cardiac Anaesthesia, St. Joseph's Regional Medical Center, Paterson, NJ 07503, USA.

Publication date & source: 2003-10, J Cardiothorac Vasc Anesth., 17(5):604-12.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: To evaluate whether intracoronary vasodilators can improve diastolic function in 32 patients with failed percutaneous transluminal coronary angioplasty (PTCA). DESIGN: Clinical trial. SETTING: Single-institution, academic hospital. PARTICIPANTS: Failed PTCA patients undergoing emergency coronary artery bypass grafting surgery. INTERVENTIONS: Patients were divided into 2 groups: group A received 0.1 mg of intracoronary nicardipine, and group B received 20 microg of intracoronary nitroglycerin. Both drugs were administrated via a coronary dilatation perfusion catheter inserted in the catheterization laboratory by the cardiologist. Subsequently, they were continuously infused via the side port of the introducer of the pulmonary artery catheter and titrated to keep systolic blood pressure at about two thirds of the control value. Transesophageal echocardiography (Power Vision/6000, 9-mm 5MHZ Probe; Toshiba, Elmsford, NY) was used in this study. MEASUREMENTS AND MAIN RESULTS: Left ventricular ejection fraction, cardiac index, tissue Doppler imaging velocity of the left ventricle and mitral annulus, and troponin levels were measured before and after administration of the 2 vasodilators and after cardiopulmonary bypass. Diastolic dysfunction was found preoperatively in all the patients and responded only to intracoronary nicardipine. Ea of mitral annulus velocity significantly increased in group A patients from 7.5 +/- 0.02 to 11.8 +/- 0.01 (p < 0.005) and decreased in group B patients from 8.0 +/- 0.03 to 7.5 +/- 0.02 after nicardipine or nitroglycerin administration. Left ventricular ejection fraction and cardiac index increased significantly (p < 0.005) only after nicardipine administration. Troponin levels were significantly lower in group A than in group B patients (p < 0.005). CONCLUSION: Intracoronary nicardipine improves diastolic function and myocardial flow velocity in patients with failed PTCA undergoing emergency coronary artery bypass graft surgery.

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