Effects of preoperative treatment with diltiazem on diastolic ventricular function after coronary artery bypass graft surgery

J Cardiothorac Vasc Anesth. 2001 Dec;15(6):710-6. doi: 10.1053/jcan.2001.28314.

Abstract

Objective: To examine whether preoperative treatment with diltiazem could ameliorate left ventricular (LV) diastolic dysfunction in patients after coronary artery bypass graft (CABG) surgery.

Design: Prospective, nonrandomized clinical study.

Setting: University hospital.

Participants: Thirty-four patients with preserved LV function undergoing elective CABG surgery.

Interventions: According to medical history, patients were divided into 2 groups: patients not receiving diltiazem (n = 17) and patients treated with once-daily oral diltiazem for at least 2 weeks (n = 17). All patients received preoperative beta-blockers.

Measurements and main results: After induction of anesthesia, after sternal closure, and 4 hours after cardiopulmonary bypass (CPB), mitral and pulmonary venous flow velocities were measured with pulsed Doppler. LV short-axis end-diastolic area by Doppler transesophageal echocardiography (TEE) and hemodynamic variables were obtained simultaneously at comparable pulmonary capillary wedge pressures. Postoperatively, increased peak E and A velocities were observed in patients with diltiazem and controls and returned to baseline 4 hours post-CPB in controls. Changes in these velocities did not result in a decreased E/A ratio. Peak A velocity, E/A ratio, and E wave deceleration time were significantly dependent on heart rate, not peak E velocity. End-diastolic area at comparable pulmonary capillary wedge pressure remained unchanged. In relation to diltiazem, only peak A velocity and time velocity integral of the A wave (TVI-A) at 4 hours post-CPB differed from controls.

Conclusion: Diastolic function is preserved after CABG surgery and is not altered by diltiazem in patients with preserved LV systolic function. The persistence of increased peak A velocity and TVI-A into the postoperative period suggests improved atrial systolic function with diltiazem.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Administration, Oral
  • Blood Flow Velocity
  • Calcium Channel Blockers / administration & dosage*
  • Cardiopulmonary Bypass
  • Coronary Artery Bypass*
  • Diastole
  • Diltiazem / administration & dosage*
  • Echocardiography, Transesophageal
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / diagnostic imaging
  • Preoperative Care*
  • Prospective Studies
  • Pulmonary Veins / diagnostic imaging
  • Ventricular Function, Left / drug effects*

Substances

  • Calcium Channel Blockers
  • Diltiazem