Effects on hemodynamics and left ventricular ejection fraction of intravenous bepridil for impaired left ventricular function secondary to coronary artery disease.

To define the hemodynamic effects of bepridil in patients with depressed left ventricular (LV) function, 22 patients with an LV ejection fraction (EF) of 0.45 or less were studied before and after 2 mg/kg (n = 11) and 4 mg/kg (n = 11) of intravenous bepridil. Maximal hemodynamic effects were evident between 15 and 30 minutes after drug infusion. After 2 mg/kg, heart rate decreased 9% (p less than 0.01), cardiac index 17% (p less than 0.01), LV dP/dt max 16% (p less than 0.01), stroke work index 14% (p less than 0.01) and mean aortic pressure 8% (difference not significant). Right atrial pressure increased 8% (not significant), pulmonary arterial wedge pressure 24% (p less than 0.01) and systemic vascular resistance 17% (p less than 0.01). After administering 4 mg/kg of bepridil the changes in heart rate, cardiac index, right atrial pressure, LV dP/dt max, mean aortic pressure and systemic vascular resistance were almost identical to those after the smaller dose. The larger dose produced a 40% (p less than 0.01) increase in pulmonary arterial wedge pressure and a 22% decrease in stroke work index (p less than 0.01), but only the change in wedge pressure was significantly greater (p less than 0.01) than that produced by the lower dose. Radionuclide-determined LVEF decreased 6% (p less than 0.05), from 0.33 +/- 0.14 after 2 mg/kg and 11% (p less than 0.05) from 0.27 +/- 0.11 after 4 mg/kg of bepridil. The data indicate that bepridil exerts significant negative inotropic and chronotropic effects in patients with impaired LV function.