Echocardiographic predictors of an adverse response to a nifedipine trial in primary pulmonary hypertension: Diminished left ventricular size and leftward ventricular septal bowing

Mark J. Ricciardi, Eduardo Bossone, David S. Bach, William F. Armstrong, Melvyn Rubenfire*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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 safely 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.

Original languageEnglish (US)
Pages (from-to)1218-1223
Number of pages6
JournalCHEST
Volume116
Issue number5
DOIs
StatePublished - 1999

Keywords

  • Echocardiography
  • Hypotension
  • Nifedipine
  • Primary pulmonary hypertension

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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