Calcium-channel blocker (CCB) may precipitate adverse events in patients with severe left ventricular (LV) dysfunction after myocardial infarction (Mi). LV dilation precedes LV dysfunction and is an independent predictor of adverse events and mortality in patients after Mi. We tested that the new-generation CCB nisoldipine (Niso), a potent vasodilator, may prevent LV dilation (remodeling) after mild asymptomatic LV-dysfunction following moderate Mi. In a prospective double-blind study, patients were randomized to placebo (P) or low-dose (10 mg/day) Niso in the first week after Mi and reexamined 2 hours, 1, 6 and 18 months later. Exclusions were clinical heart failure, uncontrolled hypertension and angina pectoris. At baseline (mean +/- sd), age was 56 +/- 8 and 56 +/- 9 years, infarct size (biplane cineangiography) 16 +/- 14 and 12 +/- 12% of LV, radionuclide LV ejection fraction (EF) 45 +/- 11 and 44 +/- 15%, end-diastolic volume (gated SPECT) 155 +/- 29 and 142 +/- 26 ml, wedge pressure (Swan-Ganz catheter) 12 +/- 4 and 12 +/- 5 mmHg in P (n = 20) and Niso (n = 15), respectively. Progressive LV dilation occurred with Niso (ANOVA p = 0.021) but not with P (figure; * p < 0.05 vs. 6 months; p < 0.05 vs. P).Thus, even new-generation vasodilating CCB such as nisoldipine may be contraindicated even at low dose in patients with mild LV dysfunction.