|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 1993; 21:182-188 © 1993 by the American College of Cardiology Foundation |
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
OBJECTIVES. The objective of this study was to ascertain whether the reversal of low peak filling rates after administration of calcium channel blockers in patients with diastolic dysfunction indicates true improvement in the rate of ventricular relaxation and left ventricular end-diastolic pressure measured by invasive indexes. BACKGROUND. Depressed filling rates measured noninvasively have been associated with diastolic dysfunction, specifically abnormal relaxation of the left ventricle. There is a reversal of these low peak filling rates after administration of calcium channel blockers. METHODS. Doppler echocardiographic measurements of peak filling rates were made and invasive high fidelity manometer-tipped pressures were measured before and after administration of verapamil (0.1 mg/kg body weight) in 20 patients with coronary artery disease who had an ejection fraction > 40% and decreased peak filling rates. RESULTS. Verapamil caused significant increases in the peak filling rate, as measured by early transmitral (E) flow velocity, from 0.57 +/- 0.16 m/s to 0.77 +/- 0.15 m/s (p < 0.01), indicating reversal of decreased peak filling rates. Concomitantly, left ventricular end-diastolic pressure increased from 18.0 +/- 7.7 mm Hg to 24.1 +/- 9.0 mm Hg (p < 0.001). The time constant of relaxation was variable, with an overall significant increase from 45.8 +/- 10.4 ms to 53.2 +/- 14.6 ms (p = 0.01). CONCLUSIONS. Verapamil administered intravenously produced reversal of decreased peak filling rates in patients with coronary artery disease and normal ventricular function. However, there was an increase in left ventricular end-diastolic pressure as well as an overall prolongation of the time constant of relaxation. Therefore, changes in peak filling rates do not accurately reflect the response of ventricular relaxation to drug interactions. Thus, calcium channel blockers should be used cautiously in the empiric treatment of patients with diastolic dysfunction.
This article has been cited by other articles:
|
|
 |
|
  M. S. Firstenberg, N. L. Greenberg, M. L. Main, J. K. Drinko, J. A. Odabashian, J. D. Thomas, and M. J. Garcia Determinants of diastolic myocardial tissue Doppler velocities: influences of relaxation and preload J Appl Physiol, January 1, 2001; 90(1): 299 - 307. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Yamamoto, J. C. Burnett Jr, M. Jougasaki, R. A. Nishimura, K. R. Bailey, Y. Saito, K. Nakao, and M. M. Redfield Superiority of Brain Natriuretic Peptide as a Hormonal Marker of Ventricular Systolic and Diastolic Dysfunction and Ventricular Hypertrophy Hypertension, December 1, 1996; 28(6): 988 - 994. [Abstract] [Full Text]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 D. G. Hurrell, R. A. Nishimura, S. T. Higano, C. P. Appleton, G. K. Danielson, D. R. Holmes Jr, and A. J. Tajik Value of Dynamic Respiratory Changes in Left and Right Ventricular Pressures for the Diagnosis of Constrictive Pericarditis Circulation, June 1, 1996; 93(11): 2007 - 2013. [Abstract] [Full Text]
|
|
|
|
|
|
R. Nagano, T. Masuyama, M. Naka, M. Hori, and T. Kamada Contribution of Atrial Reservoir Function to Ventricular Filling in Hypertensive Patients : Effects of Nifedipine Administration Hypertension, November 1, 1995; 26(5): 815 - 819. [Abstract] [Full Text]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
