Improvement in NYHA functional class 4 congestive heart failure patients with nifedipine: A hemodynamic evaluation

Twelve patients referred for evaluation of functional class 4 heart failure as classified by the New York Heart Association underwent treatment with nifedipine after other regimens proved unsatisfactory. Seven men and five women with a mean age of 63 years and a mean ejection fraction of 28% underwent hemodynamic evaluation after insertion of a pulmonary artery monitoring catheter. Nifedipine was administered as a 10 mg sublingual dose, followed by 10 mg orally every 8 hours for 24 hours. Seven patients experienced improvement of symptoms of dyspnea (group 1) and continued nifedipine as outpatients for one month. An improvement in function to class 3 (five subjects) and class 2 (two subjects) was observed. The remaining five patients experienced no improvement (group 2) and did not receive nifedipine after 24 hours. Statistical analysis of the hemodynamic variables revealed that the responders (group 1) had a significant decrease in the pulmonary vascular resistance from 250 dynes second cm^-5 at baseline to 155 dynes second cm^-5 at 15 minutes after sublingual nifedipine (p < .05) and 135 dynes second cm^-5 at 24 hours while on oral nifedipine. Although trends were seen with other variables, none was statistically significant. After one year of extended follow-up, six of seven group 1 subjects (responders) were alive, compared to only one of five group 2 subjects (p < .05). All five deaths were related to progressive deterioration of cardiac function with congestive heart failure. Although ejection fraction did not correlate with final outcome, the duration of heart failure was significantly longer in the nonresponders (p < .05). While nifedipine may not be the initial drug of choice in heart failure, it may be of benefit in carefully selected patients under monitored conditions. A decrease in the pulmonary vascular resistance may predict functional improvement.