Circulation, Vol 68, 1062-1073, Copyright © 1983 by American Heart Association
RO Bonow, HG Ostrow, DR Rosing, RO Cannon 3d, LC Lipson, BJ Maron, KM Kent, SL Bacharach and MV Green
To investigate the effects of verapamil on left ventricular systolic and
diastolic function in patients with hypertrophic cardiomyopathy, we studied
14 patients at catheterization with a nonimaging scintillation probe before
and after serial intravenous infusions of low-, medium-, and high-dose
verapamil (total dose 0.17 to 0.72 mg/kg). Percent change in radionuclide
stroke counts after verapamil correlated well with percent change in
thermodilution stroke volume (r = .87), and changes in diastolic and
systolic counts were used to assess relative changes in left ventricular
volumes after verapamil. Verapamil produced dose- related increases in
end-diastolic counts (19 +/- 9% increase; p less than .001), end-systolic
counts (91 +/- 54% increase; p less than .001), and stroke counts (7 +/-
10% increase; p less than .02). This was associated with a decrease in
ejection fraction (83 +/- 8% control, 73 +/- 10% verapamil; p less than
.001) and, in the 10 patients with left ventricular outflow tract
gradients, a reduction in gradient (62 +/- 27 mm Hg control, 32 +/- 35 mm
Hg verapamil; p less than .01). The end-systolic pressure-volume relation
was shifted downward and rightward in all patients, suggesting a negative
inotropic effect. In 10 patients, left ventricular pressure-volume loops
were constructed with simultaneous micromanometer pressure recordings and
the radionuclide time-activity curve. In five patients, verapamil shifted
the diastolic pressure-volume curve downward and rightward, demonstrating
improved pressure-volume relations despite the negative inotropic effect,
and also increased the peak rate of rapid diastolic filling. In the other
five patients, the diastolic pressure-volume relation was unaltered by
verapamil, and increased end-diastolic volumes occurred at higher
end-diastolic pressures; in these patients, the peak rate of left
ventricular diastolic filling was not changed by verapamil. The negative
inotropic effects of intravenous verapamil are potentially beneficial in
patients with hypertrophic cardiomyopathy by decreasing left ventricular
contractile function and increasing left ventricular volume. Verapamil also
enhances left ventricular diastolic filling and improves diastolic
pressure-volume relations in some patients despite its negative inotropic
effect.
ARTICLES
Effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy: pressure-volume analysis with a nonimaging scintillation probe
This article has been cited by other articles:
 |
|
 |
|
  M. A. Fifer and G. J. Vlahakes Management of Symptoms in Hypertrophic Cardiomyopathy Circulation, January 22, 2008; 117(3): 429 - 439. [Full Text] [PDF]
|
|
|
|
|
|
J. B. Geske, P. Sorajja, R. A. Nishimura, and S. R. Ommen Evaluation of Left Ventricular Filling Pressures by Doppler Echocardiography in Patients With Hypertrophic Cardiomyopathy: Correlation With Direct Left Atrial Pressure Measurement at Cardiac Catheterization Circulation, December 4, 2007; 116(23): 2702 - 2708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Lu, Y. Xu, P. Zhu, C. Greyson, and G. G. Schwartz A common mechanism for concurrent changes of diastolic muscle length and systolic function in intact hearts Am J Physiol Heart Circ Physiol, April 1, 2001; 280(4): H1513 - H1518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. F. Nagueh, N. M. Lakkis, K. J. Middleton, D. Killip, W. A. Zoghbi, M. A. Quinones, and W. H. Spencer III Changes in left ventricular filling and left atrial function six months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1123 - 1128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-H. Chen, M. Nakayama, M. Talbot, E. Nevo, B. Fetics, G. Gerstenblith, L. C. Becker, and D. A. Kass Verapamil acutely reduces ventricular-vascular stiffening and improves aerobic exercise performance in elderly individuals J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1602 - 1609. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Pak, W. L. Maughan, K. L. Baughman, R. S. Kieval, and D. A. Kass Mechanism of Acute Mechanical Benefit From VDD Pacing in Hypertrophied Heart : Similarity of Responses in Hypertrophic Cardiomyopathy and Hypertensive Heart Disease Circulation, July 21, 1998; 98(3): 242 - 248. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Hartmann, J. Schnell, R. Hopf, and G. Kneissl Persisting Effect of Ca2+-Channel Blockers on Left Ventricular Function in Hypertrophic Cardiomyopathy After 14 Years' Treatment Angiology, August 1, 1996; 47(8): 765 - 773. [Abstract] [PDF]
|
|
|
|
|
|
P. H. Pak, W. L. Maughan, K. L. Baughman, and D. A. Kass Marked Discordance Between Dynamic and Passive Diastolic Pressure-Volume Relations in Idiopathic Hypertrophic Cardiomyopathy Circulation, July 1, 1996; 94(1): 52 - 60. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. C. Robbins and E. B. Stinson LONG-TERM RESULTS OF LEFT VENTRICULAR MYOTOMY AND MYECTOMY FOR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY J. Thorac. Cardiovasc. Surg., March 1, 1996; 111(3): 586 - 594. [Abstract] [Full Text]
|
|
|
|
|
|
E. D. Wigle, H. Rakowski, B. P. Kimball, and W. G. Williams Hypertrophic Cardiomyopathy : Clinical Spectrum and Treatment Circulation, October 1, 1995; 92(7): 1680 - 1692. [Full Text]
|
|
|
|
 |
|
 R. C. Harizi, J. A. Bianco, and J. S. Alpert Diastolic Function of the Heart in Clinical Cardiology Arch Intern Med, January 1, 1988; 148(1): 99 - 109. [Abstract] [PDF]
|
|