title: Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance.
abstract: 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 greater than 45%) and abnormal diastolic filling (peak filling rate less than 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 less than 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 clinico-radiographic heart failure score (scale 0 to 13) was significantly greater with verapamil compared to placebo (median improvement in score: 3 vs 1, p less than 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.
authors.affiliation: Department of Internal Medicine, West Haven Veterans Administration Medical Center, Connecticut.
authors.forename: J F
authors.initials: JF
authors.lastname: Setaro
authors.forename: B L
authors.initials: BL
authors.lastname: Zaret
authors.forename: D S
authors.initials: DS
authors.lastname: Schulman
authors.forename: H R
authors.initials: HR
authors.lastname: Black
authors.forename: R
authors.initials: R
authors.lastname: Soufer
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D004311:Double-Blind Method; D004452:Echocardiography; D005080:Exercise Test; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013318:Stroke Volume / Q000187:drug effects; D013794:Thallium Radioisotopes; D016277:Ventricular Function, Left / Q000502:physiology*; D014700:Verapamil / Q000627:therapeutic use*
chemical_list: D013794:Thallium Radioisotopes; D014700:Verapamil