Salutary effect of disopyramide on left ventricular diastolic function in hypertrophic obstructive cardiomyopathy

Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.

OBJECTIVES. The purpose of this study was to estimate the effect of disopyramide on left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy. BACKGROUND. Although disopyramide has been reported to lessen clinical symptoms in patients with hypertrophic obstructive cardiomyopathy, few data exist regarding its effect on diastolic function in these patients. METHODS. Thirteen patients with hypertrophic cardiomyopathy (six with and seven without left ventricular outflow obstruction) were examined. Before and after intravenous disopyramide, hemodynamic and angiographic studies were performed. RESULTS. In patients with outflow obstruction, pressure gradient at the outflow tract decreased from a mean +/- SD of 100 +/- 45 to 26 +/- 33 mm Hg (p < 0.01). Although systolic function was similarly impaired in both groups, the time constant of left ventricular pressure decay (tau) shortened from 56 +/- 10 to 44 +/- 8 ms (p < 0.01) and the constant of left ventricular chamber stiffness (kc) decreased from 0.049 +/- 0.017 to 0.038 +/- 0.014 m2/ml (p < 0.01) only in patients with outflow obstruction. Shortening in tau correlated best with decrease in left ventricular systolic pressure (r = 0.84, p < 0.01). In contrast, tau was prolonged from 52 +/- 10 to 64 +/- 11 ms (p < 0.01) and kc was unchanged in patients without outflow obstruction. CONCLUSIONS. The primary effects of disopyramide on the hypertrophied left ventricle were negative inotropic and negative lusitropic. However, left ventricular diastolic properties in patients with outflow obstruction were improved with a decrease in outflow pressure gradient. Relief of clinical symptoms in hypertrophic obstructive cardiomyopathy with disopyramide might be due in part to improvement of diastolic function, which appears secondary to the reduction in ventricular afterload.

This article has been cited by other articles:

				B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 13, 2011; 58(25): 2703 - 2738. [Full Text] [PDF]

				B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 13, 2011; 58(25): e212 - e260. [Full Text] [PDF]

				Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 13, 2011; 124(24): e783 - e831. [Full Text] [PDF]

				Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 13, 2011; 124(24): 2761 - 2796. [Full Text] [PDF]

				Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): 1303 - 1338. [Full Text] [PDF]

				Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): e153 - e203. [Full Text] [PDF]

				B. B. Siswanto and R. Aryani Recent advances in diagnosis and management of hypertrophic cardiomyopathy Heart Asia, July 5, 2010; 1(1): 16 - 19. [Abstract] [Full Text] [PDF]

				M. V. Sherrid, O. Wever-Pinzon, A. Shah, and F. A. Chaudhry Reflections of Inflections in Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., July 14, 2009; 54(3): 212 - 219. [Abstract] [Full Text] [PDF]

				P. Sorajja, R. A. Nishimura, S. R. Ommen, C. S. Rihal, B. J. Gersh, and D. R. Holmes Jr Effect of Septal Ablation on Myocardial Relaxation and Left Atrial Pressure in Hypertrophic Cardiomyopathy: An Invasive Hemodynamic Study J. Am. Coll. Cardiol. Intv., October 1, 2008; 1(5): 552 - 560. [Abstract] [Full Text] [PDF]

				M. A. Fifer and G. J. Vlahakes Management of Symptoms in Hypertrophic Cardiomyopathy Circulation, January 22, 2008; 117(3): 429 - 439. [Full Text] [PDF]

				M. V. Sherrid, I. Barac, W. J. McKenna, P. M. Elliott, S. Dickie, L. Chojnowska, S. Casey, and B. J. Maron Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1251 - 1258. [Abstract] [Full Text] [PDF]

				B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1687 - 1713. [Full Text] [PDF]

				Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Eur. Heart J., November 1, 2003; 24(21): 1965 - 1991. [Full Text] [PDF]

				I. Ostman-Smith, G.o. Wettrell, and T. Riesenfeld A cohort study of childhood hypertrophic cardiomyopathy: Improved survival following high-dose beta-adrenoceptor antagonist treatment J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1813 - 1822. [Abstract] [Full Text] [PDF]

				T. Tokudome, K. Mizushige, T. Ueda, S. Sakamoto, H. Matsuo, and K. Mizushige Effect of Disopyramide on Left Ventricular Pressure Gradient in Hypertrophic Obstructive Cardiomyopathy in Comparison with Propranolol: A Case Report Angiology, April 1, 1999; 50(4): 331 - 335. [Abstract] [PDF]