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European Heart Journal 1981 2(1):21-29;
Copyright © 1981 by the European Society of Cardiology.
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© 1981, by The European Society Of Cardiology

Reappraisal of the effect of acute betablockade on left ventricular filling dynamics in hypertrophic obstructive cardiomyopathy*

K. W. SPEISER and H. P. KRAYENBUEHL

Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital Zuürich Switzerland

Received 13 June 1980; revised 17 September 1980; .

K. Speiser, MD, Medical Policlinic, Cardiology, University Hospital, 8091 Zuürich, Switzerland

Abstract

While propranolol (PR) has been shown to be effective in reducing the outflow tract gradient(OTG)in L hypertrophic obstructive cardiomyopathy, there is debate as to whether it can produce an increase of left ventricular (L V) diastolic distensibility. Biplane L V cine-angiography was carried out simultaneously with LV high-fidelity pressure measurements in nine patients with mild to moderate hypertrophic obstructive cardiomyopathy (peak OTG at rest 0 to 85 mm Hg, mean 22 mm H g) before and 15 min after i.v. PR (0.15 mg/kg body weight). Following PR, heart rate decreased from 85 to 69 beats/min (p<0.005). LV end-diaslolic volume and pressure increased insignificantly from 90 to 93 ml/ml2 and from 21 to 24 mm Hg, respectively. Frame by frame analysis of the LVcine-angiograms at 20 ms intervals was used to construct instantaneous diastolic pressure–volume curves. Although in three patients who had undergone prior myeclomy there was some right- and downward shift of the pressure–volume relationship following betablockade, the pooled data of eight patients whose individual pressure-volume relation fitted reasonably well to a monoexponential curve showed no significant change either in the constant of LV chamberl stiffness or in the pressure intercept after PR. Moreover, L Vfilling dynamics were compared at two points of the LV pressure curve (at the lowest LV pressure = point 1 and prior to the a wave m< point 2). L V inflow in ml/m2 and in per cent of stroke volume index as well as mean filling rate were similar at points 1 and 2 before and after PR. Change in LV shape index (= 4n x area/perimeter1) from end-systole to end-diastole decreased from 0.22 to O.17 (P<0.02) after PR. In conclusion, acute betablockade neither consistently alters LV distensibility as assessed by the pressure-volume relationship nor improves the extent and rate ofL V diastolic filling. In contrast, the diastolic change of geometry following PR is altered in such a way that compared to the control state, pressure independent L Vfilling is impeded rather than facilitated

Key Words: Propranolol in HOCM • diastolic distensibility in HOCM • diastolic pressure–volume relationship • ventricular filling dynamics.


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