Effect of verapamil on absolute myocardial blood flow in hypertrophic cardiomyopathy

Roberto Gistri, Franco Cecchi, Lubna Choudhury, Alessio Montereggi, Oreste Sorace, Piero A. Salvadori, Paolo G. Camici

Research output: Contribution to journalArticle

Abstract

Angina, despite angiographically normal coronary arteries, is a common symptom in patients with hypertrophic cardiomyopathy (HC). Verapamil has been shown to ameliorate silent myocardial perfusion defects documented by thallium-201 in patients with HC. The aim of this study was to investigate the effects of verapamil on absolute regional myocardial blood flow and flow reserve, measured by positron emission tomography (PET) in patients with HC. Echocardiography, exercise stress testing, and measurements of myocardial blood flow at rest and after administration of intravenous dipyridamole (0.56 mg/kg) were undertaken in 20 patients with HC at baseline study and 8 ± 2 weeks after double-blind randomization to either slow-release verapamil 240 mg or placebo once daily. During treatment, resting myocardial blood flow in the interventricular septum was 0.81 ± 0.23 versus 0.96 ± 0.42 ml/min/g in the placebo and verapamil group, respectively (p = NS between groups and when compared with respective baseline study); resting myocardial blood flow in the left ventricular free wall was 0.67 ± 0.17 versus 0.74 ± 0.45 ml/min/g, respectively (p = NS). After dipyridamole infusion, myocardial blood flow in the interventricular septum was 1.42 ± 0.52 versus 1.92 ± 1.23 ml/min/g (p = NS between groups and when compared with respective baseline study); myocardial blood flow in the left ventricular free wall was 1.25 ± 0.41 versus 1.68 ± 1.37 ml/min/g, respectively (p = NS). Coronary flow reserve before and after treatment was 1.95 ± 0.82 versus 1.86 ± 0.73 (p = NS) in the interventricular septum and 2.15 ± 0.74 versus 1.98 ± 0.69 in the left ventricular free wall (p = NS) in the placebo and verapamil groups, respectively. Evidence of subendocardial underperfusion was found in 3 of 7 patients with interventricular septal thickness > 25 mm while not receiving treatment. Two of these 3 patients received verapamil, and in 1 normalization of transmural myocardial blood flow was observed. In conclusion, short-term treatment with 240 mg of slow-release verapamil once daily does not affect absolute myocardial blood flow and coronary flow reserve in patients with HC. Subendocardial underperfusion may occur in patients with this condition and verapamil may have a positive effect on transmural blood flow distribution.

Original languageEnglish
Pages (from-to)363-368
Number of pages6
JournalThe American Journal of Cardiology
Volume74
Issue number4
DOIs
Publication statusPublished - Aug 15 1994

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Hypertrophic Cardiomyopathy
Verapamil
Dipyridamole
Placebos
Stress Echocardiography
Thallium
Regional Blood Flow
Therapeutics
Random Allocation
Intravenous Administration
Positron-Emission Tomography
Coronary Vessels
Perfusion
Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of verapamil on absolute myocardial blood flow in hypertrophic cardiomyopathy. / Gistri, Roberto; Cecchi, Franco; Choudhury, Lubna; Montereggi, Alessio; Sorace, Oreste; Salvadori, Piero A.; Camici, Paolo G.

In: The American Journal of Cardiology, Vol. 74, No. 4, 15.08.1994, p. 363-368.

Research output: Contribution to journalArticle

Gistri, R, Cecchi, F, Choudhury, L, Montereggi, A, Sorace, O, Salvadori, PA & Camici, PG 1994, 'Effect of verapamil on absolute myocardial blood flow in hypertrophic cardiomyopathy', The American Journal of Cardiology, vol. 74, no. 4, pp. 363-368. https://doi.org/10.1016/0002-9149(94)90404-9
Gistri R, Cecchi F, Choudhury L, Montereggi A, Sorace O, Salvadori PA et al. Effect of verapamil on absolute myocardial blood flow in hypertrophic cardiomyopathy. The American Journal of Cardiology. 1994 Aug 15;74(4):363-368. https://doi.org/10.1016/0002-9149(94)90404-9
Gistri, Roberto ; Cecchi, Franco ; Choudhury, Lubna ; Montereggi, Alessio ; Sorace, Oreste ; Salvadori, Piero A. ; Camici, Paolo G. / Effect of verapamil on absolute myocardial blood flow in hypertrophic cardiomyopathy. In: The American Journal of Cardiology. 1994 ; Vol. 74, No. 4. pp. 363-368.
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abstract = "Angina, despite angiographically normal coronary arteries, is a common symptom in patients with hypertrophic cardiomyopathy (HC). Verapamil has been shown to ameliorate silent myocardial perfusion defects documented by thallium-201 in patients with HC. The aim of this study was to investigate the effects of verapamil on absolute regional myocardial blood flow and flow reserve, measured by positron emission tomography (PET) in patients with HC. Echocardiography, exercise stress testing, and measurements of myocardial blood flow at rest and after administration of intravenous dipyridamole (0.56 mg/kg) were undertaken in 20 patients with HC at baseline study and 8 ± 2 weeks after double-blind randomization to either slow-release verapamil 240 mg or placebo once daily. During treatment, resting myocardial blood flow in the interventricular septum was 0.81 ± 0.23 versus 0.96 ± 0.42 ml/min/g in the placebo and verapamil group, respectively (p = NS between groups and when compared with respective baseline study); resting myocardial blood flow in the left ventricular free wall was 0.67 ± 0.17 versus 0.74 ± 0.45 ml/min/g, respectively (p = NS). After dipyridamole infusion, myocardial blood flow in the interventricular septum was 1.42 ± 0.52 versus 1.92 ± 1.23 ml/min/g (p = NS between groups and when compared with respective baseline study); myocardial blood flow in the left ventricular free wall was 1.25 ± 0.41 versus 1.68 ± 1.37 ml/min/g, respectively (p = NS). Coronary flow reserve before and after treatment was 1.95 ± 0.82 versus 1.86 ± 0.73 (p = NS) in the interventricular septum and 2.15 ± 0.74 versus 1.98 ± 0.69 in the left ventricular free wall (p = NS) in the placebo and verapamil groups, respectively. Evidence of subendocardial underperfusion was found in 3 of 7 patients with interventricular septal thickness > 25 mm while not receiving treatment. Two of these 3 patients received verapamil, and in 1 normalization of transmural myocardial blood flow was observed. In conclusion, short-term treatment with 240 mg of slow-release verapamil once daily does not affect absolute myocardial blood flow and coronary flow reserve in patients with HC. Subendocardial underperfusion may occur in patients with this condition and verapamil may have a positive effect on transmural blood flow distribution.",
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AU - Camici, Paolo G.

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N2 - Angina, despite angiographically normal coronary arteries, is a common symptom in patients with hypertrophic cardiomyopathy (HC). Verapamil has been shown to ameliorate silent myocardial perfusion defects documented by thallium-201 in patients with HC. The aim of this study was to investigate the effects of verapamil on absolute regional myocardial blood flow and flow reserve, measured by positron emission tomography (PET) in patients with HC. Echocardiography, exercise stress testing, and measurements of myocardial blood flow at rest and after administration of intravenous dipyridamole (0.56 mg/kg) were undertaken in 20 patients with HC at baseline study and 8 ± 2 weeks after double-blind randomization to either slow-release verapamil 240 mg or placebo once daily. During treatment, resting myocardial blood flow in the interventricular septum was 0.81 ± 0.23 versus 0.96 ± 0.42 ml/min/g in the placebo and verapamil group, respectively (p = NS between groups and when compared with respective baseline study); resting myocardial blood flow in the left ventricular free wall was 0.67 ± 0.17 versus 0.74 ± 0.45 ml/min/g, respectively (p = NS). After dipyridamole infusion, myocardial blood flow in the interventricular septum was 1.42 ± 0.52 versus 1.92 ± 1.23 ml/min/g (p = NS between groups and when compared with respective baseline study); myocardial blood flow in the left ventricular free wall was 1.25 ± 0.41 versus 1.68 ± 1.37 ml/min/g, respectively (p = NS). Coronary flow reserve before and after treatment was 1.95 ± 0.82 versus 1.86 ± 0.73 (p = NS) in the interventricular septum and 2.15 ± 0.74 versus 1.98 ± 0.69 in the left ventricular free wall (p = NS) in the placebo and verapamil groups, respectively. Evidence of subendocardial underperfusion was found in 3 of 7 patients with interventricular septal thickness > 25 mm while not receiving treatment. Two of these 3 patients received verapamil, and in 1 normalization of transmural myocardial blood flow was observed. In conclusion, short-term treatment with 240 mg of slow-release verapamil once daily does not affect absolute myocardial blood flow and coronary flow reserve in patients with HC. Subendocardial underperfusion may occur in patients with this condition and verapamil may have a positive effect on transmural blood flow distribution.

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