TY - JOUR
T1 - Sildenafil and diastolic dysfunction after acute myocardial infarction in patients with preserved ejection fraction
T2 - The sildenafil and diastolic dysfunction after acute myocardial infarction (SIDAMI) trial
AU - Andersen, Mads J.
AU - Ersbøll, Mads
AU - Axelsson, Anna
AU - Gustafsson, Finn
AU - Hassager, Christian
AU - Køber, Lars
AU - Borlaug, Barry A.
AU - Boesgaard, Søren
AU - Skovgaard, Lene T.
AU - Møller, Jacob E.
PY - 2013/3/19
Y1 - 2013/3/19
N2 - Background: Diastolic dysfunction is frequently seen after myocardial infarction and is characterized by a disproportionate increase in filling pressure during exercise to maintain stroke volume. We hypothesized that sildenafil would reduce filling pressure during exercise in patients with diastolic dysfunction after myocardial infarction. Methods and Results: Seventy patients with diastolic dysfunction and near normal left ventricular ejection fraction on echocardiography were randomly assigned sildenafil 40 mg thrice daily or matching placebo for 9 weeks. Before randomization and after 9 weeks of treatment patients underwent simultaneous echocardiography and right heart catheterization at rest and during exercise. Primary end point was pulmonary capillary wedge pressure, and secondary end points comprised cardiac index and pulmonary arterial pressure at rest and during exercise after 9 weeks. After 9 weeks there were no differences in pulmonary capillary wedge pressure at rest (13±4 versus 13±3 mm Hg, P=0.25) or at peak exercise (35±8 mm Hg versus 31±7 mm Hg, P=0.07). However, with treatment cardiac index increased at rest (P=0.006) and peak exercise (P=0.02) in the sildenafil group, and systemic vascular resistance index (resting, P=0.0002; peak exercise, P=0.007) and diastolic blood pressure (resting, P=0.005; peak exercise, P=0.02) were lower in the sildenafil group. Resting left ventricular end-diastolic volume index increased (P=0.001) within the sildenafil group but was unchanged in the placebo group. Conclusions: Sildenafil did not decrease filling pressure at rest or during exercise in post-myocardial infarction patients with diastolic dysfunction. However, there were effects on secondary end points, which require further studies. Clinical Trial Registration: URL: http://www.clinicaltrials. gov/ct2/show/NCT01046838. Unique identifier: NCT01046838.
AB - Background: Diastolic dysfunction is frequently seen after myocardial infarction and is characterized by a disproportionate increase in filling pressure during exercise to maintain stroke volume. We hypothesized that sildenafil would reduce filling pressure during exercise in patients with diastolic dysfunction after myocardial infarction. Methods and Results: Seventy patients with diastolic dysfunction and near normal left ventricular ejection fraction on echocardiography were randomly assigned sildenafil 40 mg thrice daily or matching placebo for 9 weeks. Before randomization and after 9 weeks of treatment patients underwent simultaneous echocardiography and right heart catheterization at rest and during exercise. Primary end point was pulmonary capillary wedge pressure, and secondary end points comprised cardiac index and pulmonary arterial pressure at rest and during exercise after 9 weeks. After 9 weeks there were no differences in pulmonary capillary wedge pressure at rest (13±4 versus 13±3 mm Hg, P=0.25) or at peak exercise (35±8 mm Hg versus 31±7 mm Hg, P=0.07). However, with treatment cardiac index increased at rest (P=0.006) and peak exercise (P=0.02) in the sildenafil group, and systemic vascular resistance index (resting, P=0.0002; peak exercise, P=0.007) and diastolic blood pressure (resting, P=0.005; peak exercise, P=0.02) were lower in the sildenafil group. Resting left ventricular end-diastolic volume index increased (P=0.001) within the sildenafil group but was unchanged in the placebo group. Conclusions: Sildenafil did not decrease filling pressure at rest or during exercise in post-myocardial infarction patients with diastolic dysfunction. However, there were effects on secondary end points, which require further studies. Clinical Trial Registration: URL: http://www.clinicaltrials. gov/ct2/show/NCT01046838. Unique identifier: NCT01046838.
KW - Cardiac catheterization
KW - Echocardiography
KW - Exercise
KW - Myocardial infarction
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U2 - 10.1161/CIRCULATIONAHA.112.000056
DO - 10.1161/CIRCULATIONAHA.112.000056
M3 - Article
C2 - 23406672
AN - SCOPUS:84875231565
SN - 0009-7322
VL - 127
SP - 1200
EP - 1208
JO - Circulation
JF - Circulation
IS - 11
ER -