Patients with post-MI diastolic dysfunction: does Sildenafil enhance their condition?

Sildenafil does not decrease pressure in the patients with diastolic dysfunction caused by myocardial infarction do exercises or have rest.

Dr. Mads J. Andersen from Copenhagen started research with his team where he explored work of PDE5 inhibitor in men who suffered from abnormal filling pressure when they were doing sports to figure out if this could help to avoid development of asymptomatic heart failure to symptomatic.

Dr. Andersen explained the reason for research conducted for these patients. The men from this group have bigger percent of mortality among them. They are more vulnerable physically as well.

As a rule, such patients leave the hospital too early, in the opinion of Dr. Andersen. It seems that they feel well and do not need medical assistance any longer. The patients may not understand that they risk much. The abnormal pressure is not evident. During exercises they can have heart failure. Some of the patients developed pulmonary edema.

When patients take Sildenafil, maladaptive myocardial remodeling decreases when pressure overload cases occur. Sildenafil is able to enhance vasodilation. The team of researchers state that it brings beneficial hemodynamic effects without risk of formation of systemic hypertension.

For more detailed examination of the medication in patients suffering from diastolic dysfunction and problematic ejection, 70% of the patients were given sildenafil. They received 40 milligrams dose. Others obtained placebo. The medication was taken three times per day. The study continued for 9 weeks. 61% were men. 32 days (average figure) passed from myocardial infarction to randomization.

Prior to randomization and during the study the patients underwent echography and right heart catheterization at the moment of exercises and rest. PCWP (pulmonary capillary wedge pressure) was the main result of the study.

The lead author of the study and his colleagues revealed that pulmonary capillary wedge pressure did not change at the moments of rest and even during exercises in patients who took sildenafil. However, the result was considerably better in sildenafil group. These patients had better cardiac index when they had rest and did exercises. Systemic vascular resistance index was decreased in this group.

Such influence upon secondary endpoints requires the research to be continued.

25% of patients with heart attack have diastolic dysfunction with standard LVEF. The figure was provided by Dr. Andersen. The team wants to study other medicines further, for instance, aldosterone inhibitors. Besides, they’ll examine the data obtained from this research.

The experts of the team added that they are interested in the mechanics of the effect. It is very important to make more comprehensive examination during which the causes are studied along with symptoms. The matter is that wedge pressure is not the cause of the problem but the symptom that needs to be removed. The cause should be found in order to solve the problem. Only at this condition it is going to be solved. One needs to get rid of underlying disease for that.

Anyway, patients who had heart attack previously with diastolic dysfunction should not give up physical load but they should be cautious at that. It is recommended to stop after faints, sickness, pain and breathing difficulties.