Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance

• Published in: The American journal of cardiology Vol. 66; no. 12; pp. 981 - 986
• Main Authors: Setaro, John F., Zaret, Barry L., Schulman, Douglas S., Black, Henry R., Soufer, Robert
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.10.1990
• Subjects: 550601 - Medicine- Unsealed Radionuclides in Diagnostics; Aged; BETA DECAY RADIOISOTOPES; BIOLOGICAL EFFECTS; Blood Pressure - drug effects; BODY; CARDIOVASCULAR AGENTS; CARDIOVASCULAR DISEASES; CARDIOVASCULAR SYSTEM; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSIS; DIAGNOSTIC TECHNIQUES; Diastole - drug effects; Diastole - physiology; DISEASES; Double-Blind Method; DRUGS; Echocardiography; ELECTRON CAPTURE RADIOISOTOPES; EXERCISE; Exercise Test; HEART; Heart Failure - diagnostic imaging; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart Rate - drug effects; HEAVY NUCLEI; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; Male; Middle Aged; NUCLEI; ODD-EVEN NUCLEI; ORGANS; PATIENTS; Prospective Studies; RADIOISOTOPE SCANNING; RADIOISOTOPES; RADIOLOGY AND NUCLEAR MEDICINE; Radionuclide Imaging; SCINTISCANNING; SECONDS LIVING RADIOISOTOPES; Stroke Volume - drug effects; THALLIUM 201; THALLIUM ISOTOPES; Thallium Radioisotopes; VASODILATORS; Ventricular Function, Left - physiology; Verapamil - therapeutic use
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(90)90937-V

Normal left ventricular systolic performance with impaired left ventricular diastolic filling may be present in a substantial number of patients with congestive heart failure (CHF). To evaluate the effect of oral verapamil in this subset, 20 men (mean age 68 ± 5 years) with CHF, intact left ventricular function (ejection fraction >45%) and abnormal diastolic filling (peak filling rate <2.5 end-diastolic volumes per second [edv/s]) were studied in a placebo-controlled, double-blind 5-week crossover trial. All patients underwent echocardiography to rule out significant valvular disease, and thallium-201 stress scintigraphy to exclude major active ischemia. Compared to baseline values, verapamil significantly improved exercise capacity by 33% (13.9 ± 4.3 vs 10.7 ± 3.4 minutes at baseline) and peak filling rate by 30% (2.29 ± 0.54 vs 1.85 ± 0.45 edv/s at baseline) (all p < 0.05). Placebo values were 12.3 ± 4.0 minutes and 2.16 ± 0.48 edv/s, respectively (difference not significant for both). Improvement from baseline in an objective clinicoradiographic heart failure score (scale 0 to 13) was significantly greater with verapamil compared to placebo (median improvement in score: 3 vs 1, p < 0.01). Mean ejection fraction and systolic blood pressure were unchanged from baseline; diastolic blood pressure and heart rate decreased to a small degree. Verapamil may have therapeutic efficacy in patients with CHF, preserved systolic function and impaired diastolic filling.