Copyright © 1993 by the European Society of Cardiology.
© 1993 The European Society of Cardiology
The acute response of left ventricular filling dynamics to intravenous verapamil predicts the changes in exercise tolerance after oral verapamil therapy in patients with hypertrophic cardiomyopathy
*The Second Department of Cardiology, Silesian Medical Academy Curie-Sklodowskiej 10, 41-800 Zabrze, Poland
The Cardiovascular Research Foundation 9 Kehilat Sofia St., 69018 Tel-Aviv, Israel
Received 12 July 1991; revised 18 August 1992; .
Correspondence: M. Tendera, The Second Department of Cardiology, Silesian Medical Academy, Curie-Sklodowskiej 10, 41-800 Zabrez, Poland
Abstract
We studied the correlation between changes in left ventricular filling dynamics induced by acute intravenous administration of verapamil and the changes in exercise tolerance induced by oral administration of the agent in 30 patients with hypertrophic cardiomyopathy. Diastolic cardiac function was measured by means of a nuclear stethoscope before and 10 min after intravenous administration of verapamil, 0.15mg. kg–1 over 2 min. Treadmill exercise tests using a modified Bruce protocol were performed before the initiation of oral verapamil treatment and after 4 weeks of oral therapy at a dose of 320–360 mg. day–1 (mean±SD 332±17mg. day–1).
Peak filling rate (PFR) increased in 21 patients, 18 of whom (86%) also had an increase in exercise duration. PFR showed no increase in nine patients, eight of whom (89%) had no change in exercise duration (sensitivity 95%, specificity 73%, predictive value of the positive result 86%, predictive value of the negative result 89%). Acute changes in time from the beginning of rapid filling to PFR (t-PFR) and in left ventricular end-diastolic volume (EDV) were less useful in predicting improvement in exercise tolerance. In 19 patients the changes in PFR and EDV parallelled. Twelve of the 13 patients (92%) will an increase in both parameters also had an increase in exercise duration, whereas all six in whom these parameters were reduced showed no increase in exercise duration (sensitivity 100%, specificity 86%, predictive value of positive results 92%, and predictive value of negative results 100%).
In conclusion, the response of PFR, and even more so the combined response of PFR and EDV to intravenous verapamil, accurately identify patients with hypertrophic cardiomyopathy who are likely to show improvement in exercise tolerance after oral verapamil therapy.
Key Words: Hypertrophic cardiomyopathy • filling dynamics • exercise tolerance
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