The effect of landiolol on hemodynamics and left ventricular function in patients with coronary artery disease.

STUDY OBJECTIVE

To examine the effect of landiolol (normal dose) on hemodynamics and left ventricular (LV) function.

DESIGN

Prospective, observational, repeated-measures study.

SETTING

University hospital.

PATIENTS

56 adult patients who were diagnosed with angina pectoris and who underwent elective off-pump coronary artery bypass surgery.

INTERVENTIONS

Patients were divided into two groups based on a preoperative LV ejection fraction (EF) 50% or higher (normal EF group, n = 28) and lower than 50% (low EF group, n = 28). Hemodynamics and LV function were recorded using a pulmonary artery catheter and transesophageal echocardiography at three time points (before administration of landiolol, immediately before completion of administration, and 15 minutes after completion of administration).

MEASUREMENTS

Individual hemodynamic data were obtained using a pulmonary artery catheter, and individual parameters were determined from LV short-axis views in transesophageal echocardiography.

MAIN RESULTS

Mean preoperative EFs were 57% +/- 5% and 47% +/- 3% in the normal and low EF groups, respectively. In both groups, landiolol produced a significant decrease in heart rate (HR), which then returned to baseline 15 minutes after completion of administration. A significant decrease in mean arterial pressure occurred in the low EF group, but the decrease was within 30% of baseline. In the normal EF group, there was no decrease in cardiac index, but a significant increase in stroke index, in addition to an increase in stroke volume. In the low EF group, cardiac index significantly decreased along with the decrease in HR, but there was no increase in end-diastolic volume or stroke volume.

CONCLUSIONS

Administration of landiolol using the presently recommended dosage and administration route causes a decrease in HR without aggravation of hemodynamics in patients with normal cardiac function, but in patients with preoperative EF lower than 50%, it may lead to further deterioration of cardiac function due to a decrease in HR.