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Original Articles

Cardiac function and central haemodynamics in severe chronic obstructive lung disease. Acute and long-term effects of felodipine

Eleven patients, with advanced chronic obstructive lung disease (COLD), received an infusion of the calcium antagonist felodipine at a rate of 0.9 mg/h. Pulmonary and systemic vascular resistances (PVR and SVR) at rest were reduced by 18% (p less than 0.05) and 33% (p less than 0.001), respectively. Cardiac output increased by 33%. The right ventricular and left ventricular ejection fractions (RVEF and LVEF), measured by equilibrium gated radionuclide ventriculography, increased by 32% (p less than 0.01) and 25% (p less than 0.01), respectively. During exercise both PVR and SVR fell by a mean of 30% (p less than 0.01). RVEF and LVEF both increased by about 14% (p less than 0.05 and p less than 0.01). After three months of oral felodipine treatment, a dose-related decrease in PVR was noted at rest (r = -0.83) compared with pretreatment values. There was an increase in RVEF which correlated to a reduction in PVR (r = -0.76). Three patients discontinued the trial due to side effects. It is concluded that the reduction of PVR induced by felodipine is accompanied by an improvement in right heart function as measured by ejection fraction measurements.