Circulation, Vol 72, 853-864, Copyright © 1985 by American Heart Association
RO Bonow, V Dilsizian, DR Rosing, BJ Maron, SL Bacharach and MV Green
Verapamil improves exercise tolerance and decreases symptoms in many
patients with hypertrophic cardiomyopathy. The mechanisms responsible for
these effects are not completely understood, although previous studies
indicate that verapamil enhances left ventricular relaxation and diastolic
filling in such patients. To investigate the association between changes in
left ventricular filling and exercise tolerance after verapamil, we studied
55 patients with hypertrophic cardiomyopathy by radionuclide angiography
and graded treadmill testing before and after 1 to 4 weeks of therapy with
orally administered verapamil, 320 to 640 mg/d. The verapamil-induced
increase in peak left ventricular filling rate at rest (from 3.1 +/- 1.3 to
3.7 +/- 1.3 end- diastolic volumes/sec; p less than .001) was associated
with an increase in exercise tolerance (from 5.9 +/- 3.6 to 8.7 +/- 4.7
min; p less than .001); exercise capacity increased in 34 of 43 patients
(79%) manifesting an increase in peak filling rate but only one of 12
patients (8%) with unchanged or decreased peak filling rate (p less than
.001). This initial trend persisted in 25 patients studied after 1 year of
therapy; 11 of 16 patients (69%) with a persistent increase in peak filling
rate had persistent improvement in exercise tolerance relative to
preverapamil values, compared with only one of nine patients (11%) in whom
peak filling rate was unchanged or decreased relative to preverapamil
levels (p less than .02). Verapamil withdrawal after 1 to 2 years in 24
patients resulted in reduction in peak filling rate (p less than .001) and
was associated with deterioration in exercise tolerance in 17 patients
(71%). Hence, verapamil-induced changes in left ventricular peak filling
rate were associated significantly with objective symptomatic improvement.
These data support the concept that enhanced left ventricular diastolic
filling is an important mechanism contributing to the clinical improvement
experienced by many patients with hypertrophic cardiomyopathy during
therapy with verapamil.
ARTICLES
Verapamil-induced improvement in left ventricular diastolic filling and increased exercise tolerance in patients with hypertrophic cardiomyopathy: short- and long-term effects
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