Related Experiment Videos
Persisting effect of Ca(2+)-channel blockers on left ventricular function in hypertrophic cardiomyopathy after 14
A Hartmann1, J Schnell, R Hopf
1Department of Interventional Cardiology, St. Georg Medical Center, Leipzig, Germany.
Insights
Long-term use of calcium channel blockers, like verapamil, improves diastolic filling in hypertrophic cardiomyopathy patients. Withdrawal significantly reduces early diastolic inflow, confirming persistent benefits.
Area of Science:
- Cardiology
- Pharmacology
- Echocardiography
Background:
- Calcium channel blockers (verapamil type) show benefits in hypertrophic cardiomyopathy (HCM).
- Verapamil's effects are linked to improved diastolic filling.
- Persistence of diastolic filling improvement after long-term therapy in HCM is unknown.
Purpose of the Study:
- To evaluate the persistent effect of long-term calcium channel blocker therapy on left ventricular diastolic function in hypertrophic cardiomyopathy patients.
- To assess changes in diastolic function after withdrawal of calcium channel blockers.
Main Methods:
- Fourteen patients with hypertrophic cardiomyopathy, treated long-term with verapamil or gallopamil, underwent assessment.
- Diastolic function was evaluated at rest and during exercise, both during therapy and after 5-9 days of withdrawal.
- Pulsed Doppler echocardiography measured diastolic mitral flow profiles.
Main Results:
- Withdrawal of calcium channel blockers significantly reduced early diastolic inflow velocity at rest.
- This reduction in early diastolic inflow velocity was also observed during exercise.
- Long-term therapy demonstrated a persistent improvement in early diastolic filling.
Conclusions:
- Calcium channel blockers of the phenylalkylamine type provide persistent improvement in early diastolic filling in hypertrophic cardiomyopathy.
- These findings support the continued use of these agents for managing diastolic dysfunction in HCM.
- Diastolic function parameters are positively influenced by long-term calcium channel blocker treatment in HCM.
Abstract:
Ca(2+)-channel blockers of the verapamil type have been reported to exert a beneficial effect on clinical symptoms and survival rates in hypertrophic cardiomyopathy. The effects of verapamil have been attributed predominantly to an improved diastolic filling. It is unknown whether an effect on diastolic filling persists in these patients after long-term treatment. Fourteen patients (12 men, 2 women, median age fifty-one [thirty-two to fifty-five] years) with hypertrophic cardiomyopathy were included in the study. Patients had been treated with verapamil 240-480 mg/d or gallopamil 150-200 mg/d for fourteen (seven to seventeen) years. The effect of a withdrawal of Ca(2+)-channel blockers on parameters of left ventricular diastolic function was evaluated at rest and during exercise in patients with hypertrophic cardiomyopathy after long-term therapy. Investigations were performed at rest and during supine ergometric exercise during ongoing Ca(2+)-channel blocking therapy and after five (four to nine) days' withdrawal (control). Pulsed Doppler echocardiography was used to record diastolic mitral flow profiles from an apical four-chamber view. Withdrawal of Ca(2+)-channel blockers of the phenylalkylamine type after long-term treatment of hypertrophic cardiomyopathy resulted in a significant reduction of early diastolic inflow velocity at rest and during exercise. In conclusion, these results indicate a persistent improvement of early diastolic filling by Ca(2+)-channel blockers even after long-term treatment.