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The effect of verapamil on left ventricular remodelling and diastolic function after acute myocardial infarction (the
E Natale1, M Tubaro, G Di Marcotullio
1Coronary Care Unit, San Camillo Hospital, Rome, Italy. ENRICO.NATALE@flashnet.it
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Early verapamil administration in acute myocardial infarction patients prevents diastolic dysfunction without affecting ventricular remodeling. This study highlights verapamil
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Anterior acute myocardial infarction (AMI) can lead to left ventricular remodeling and diastolic dysfunction.
- Thrombolysis is a standard treatment for AMI, but post-infarction cardiac function requires further management.
- Early intervention may mitigate adverse cardiac changes following AMI.
Purpose of the Study:
- To evaluate the impact of early and prolonged verapamil administration on left ventricular geometry and diastolic function.
- To assess verapamil's efficacy in patients with anterior AMI treated with thrombolysis and preserved systolic function.
- To determine the safety profile of verapamil in this patient population.
Main Methods:
- A double-blind, randomized, placebo-controlled study (VISOR) involving 70 patients with anterior AMI.
- Patients received intravenous verapamil or placebo within 12 hours of thrombolysis, followed by oral administration for 6 months.
- Echocardiography assessed left ventricular volumes, ejection fraction, sphericity index, and diastolic function parameters (E/A ratio, IVRT, tau) at multiple time points.
Main Results:
- Verapamil did not significantly alter left ventricular volumes, ejection fraction, or sphericity index.
- The placebo group showed impaired diastolic function (reduced E/A ratio, increased A integral, prolonged deceleration times, increased IVRT and tau).
- Verapamil treatment prevented these diastolic function alterations observed in the placebo group, with no significant changes in vital signs or biochemical parameters.
Conclusions:
- Early and prolonged verapamil administration effectively prevents diastolic dysfunction in patients with thrombolysed anterior AMI and preserved systolic function.
- Verapamil does not influence ventricular remodeling but offers a protective effect on diastolic function.
- Verapamil demonstrates a favorable safety profile in this clinical setting.
Abstract:
The VISOR is a double blind, randomized, placebo-controlled study aimed to assess the effects of early and prolonged administration of verapamil on the left ventricular geometry and diastolic function in patients with anterior acute myocardial infarction treated with thrombolysis. Patients with heart failure or ejection fraction < 45% were excluded. Within 12 hours from starting thrombolysis, 70 patients were given verapamil (5 mg/hour intravenously for the first 24 hours, followed by 120 mg t.i.d. perorally for 6 months) or equivalent placebo. Echocardiograms were performed on admittance, before discharge, after 3 months and 6 months. The following parameters were calculated: left ventricular volumes, ejection fraction, sphericity index, early (E) and late (A) transmitral peak flow velocities and time-velocity integrals with their ratios, deceleration time and half-time of E, isovolumic relaxation time (IVRT), and non-invasive time constant of ventricular relaxation (tau). The basal and the last available parameters were considered for statistical analysis. The effects of the treatment on the left ventricular volumes, ejection fraction, and sphericity index were not statistically relevant. Conversely, a reduction of E/A ratio (P < .05) and increases of A integral (P < .01), deceleration time and half-time of E, IVRT and tau (P < .05) were found in the placebo group and not in the verapamil group. No significant changes in the blood pressure, heart rate, PQ interval, and biochemical parameters were observed in the two groups. In conclusion, in patients with a thrombolysed anterior acute myocardial infarction and preserved systolic function, verapamil can prevent alterations of the diastolic function in absence of effect on ventricular remodelling, and has a good safety profile.