HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Ricciardi, M. J. Articles by Rubenfire, M. Search for Related Content PubMed PubMed Citation Articles by Ricciardi, M. J. Articles by Rubenfire, M.

Echocardiographic Predictors of an Adverse Response to a Nifedipine Trial in Primary Pulmonary Hypertension^*

Diminished Left Ventricular Size and Leftward Ventricular Septal Bowing

^* From the Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI.

Correspondence to: Melvyn Rubenfire, MD, University of Michigan Health System, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106-0363; e-mail: Mrubenfi{at}umich.edu

Background: The clinical course in primary pulmonary hypertension (PPH) is improved by calcium channel blocker therapy in those with a favorable hemodynamic response during a trial of high-dose oral nifedipine. Although trials of nifedipine are performed only in patients who demonstrate pulmonary vasodilator reserve to short-acting agents, this response does not predict the safety of nifedipine treatment, which can result in severe first-dose hypotension and death.

Study objectives: To identify echocardiographic parameters that predict first-dose nifedipine-induced hypotension in patients with PPH.

Methods: The pretrial echocardiograms of 23 consecutive PPH patients (mean age, 42.3 ± 13 years; 77% female) undergoing evaluation of pulmonary vasodilator reserve with nifedipine were analyzed. Patients were classified as those who suffered first-dose nifedipine hypotension (group 1) and those who did not (group 2). Echocardiographic measures of chamber size and septal geometry in the two groups were compared.

Results: Five measures reflecting diminished left ventricular (LV) size and leftward ventricular septal bowing were found to be associated with nifedipine hypotension: LV transverse diameter in systole (LVDs; p = 0.007), LV transverse diameter in diastole (LVDd; p = 0.05), LV area in systole (LVAs; p = 0.009), LV area in diastole (LVAd; p = 0.03), the ratio of RV to LVAs (p = 0.02), and leftward ventricular septal bowing (p = 0.01). The LV dimensions found to best predict nifedipine-induced hypotension were LVDs < 2.7 cm, LVDd < 4.0 cm, LVAs < 15.5 cm², and LVAd < 20.0 cm².

Conclusions: Readily available echocardiographic parameters in patients with PPH are predictive of nifedipine-induced hypotension, and can be used to select patients in whom a trial of nifedipine should be avoided.

Key Words: echocardiography • hypotension • nifedipine • primary pulmonary hypertension

This article has been cited by other articles:

				E. Bossone, B. D. Bodini, A. Mazza, and L. Allegra Pulmonary Arterial Hypertension: The Key Role of Echocardiography Chest, May 1, 2005; 127(5): 1836 - 1843. [Abstract] [Full Text] [PDF]

				R. J. Roeleveld, J. T. Marcus, T. J. C. Faes, T.-J. Gan, A. Boonstra, P. E. Postmus, and A. Vonk-Noordegraaf Interventricular Septal Configuration at MR Imaging and Pulmonary Arterial Pressure in Pulmonary Hypertension Radiology, March 1, 2005; 234(3): 710 - 717. [Abstract] [Full Text] [PDF]

				J. T. Marcus, A. Vonk Noordegraaf, R. J. Roeleveld, P. E. Postmus, R. M. Heethaar, A. C. Van Rossum, and A. Boonstra Impaired Left Ventricular Filling Due to Right Ventricular Pressure Overload in Primary Pulmonary Hypertension : Noninvasive Monitoring Using MRI Chest, June 1, 2001; 119(6): 1761 - 1765. [Abstract] [Full Text] [PDF]