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[Hemodynamic effects on intravenous propafenone in hypertrophic myocardiopathy]
F Funck1, C Bourmayan, P Cristofini
1Service de cardiologie, Hôpital Boucicaut, Paris.
Insights
Intravenous propafenone effectively reduced left ventricular outflow tract obstruction in hypertrophic cardiomyopathy patients unresponsive to other treatments. However, it did not improve diastolic function, necessitating further oral studies.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Hypertrophic cardiomyopathy (HCM) presents challenges with current treatments.
- 11 HCM patients with ineffective or poorly tolerated standard therapies were studied.
Purpose:
- To investigate the hemodynamic effects of intravenous propafenone in HCM patients.
- To assess propafenone's impact on left ventricular outflow tract obstruction and diastolic function.
Summary:
- Propafenone, an anti-arrhythmic with beta-blocking and amiodarone-like properties, was administered intravenously to 11 HCM patients.
- The drug reduced baseline and induced left intraventricular pressure gradients significantly (30.4 to 17.7 mmHg and 74 to 43 mmHg, respectively).
- No beneficial effect on diastolic function was observed, with a decrease in dp/dt min and an increase in T value.
Impact:
- Intravenous propafenone demonstrates potential in reducing left ventricular obstruction in specific HCM cases.
- Further long-term oral studies are required to accurately determine propafenone's role in HCM management.
Abstract:
None of the medical treatments of hypertrophic cardiomyopathy is perfect. In the present study conducted on 11 patients with hypertrophic cardiomyopathy in whom the usual treatments were either ineffective or badly tolerated, the haemodynamic effects of propafenone administered intravenously were investigated. The drug was injected centrally in doses of 2 mg/kg over 10 minutes, then by continuous intravenous infusion of 1.5 mg/min during 30 minutes. Various parameters were recorded before and after propafenone treatment by right and left cardiac catheterization. This anti-arrhythmic drug, which has beta-blocking and amiodarone-like properties, reduced left intraventricular obstruction but had no beneficial effect on diastolic function. The baseline and induced left intraventricular gradients were reduced from 30.4 to 17.7 mmHg and from 74 to 43 mmHg respectively. Diastolic function values showed a fall in dp/dt min from 1470 to 1307 mm/sec and an increase in T value from 0.066 to 0.084. The use of propafenone in hypertrophic cardiomyopathy must be accurately determined by long-term oral studies.