An equation to predict the changes in peak left ventricular pressure in hypertrophic obstructive cardiomyopathy after treatment: application to the administration of disopyramide.
A theoretical equation was derived based on the time-varying elastance model to predict theoretically the relationship between the delay in the onset of left ventricular outflow obstruction and the reduction in peak left ventricular pressure (LVP) caused by treatment in hypertrophic obstructive cardiomyopathy (HOCM). ECG, LVP, and other hemodynamic parameters were measured during catheterization at a constant heart rate with atrial pacing in 16 patients with HOCM before and after intravenous administration of disopyramide (1 mg/kg). After disopyramide administration, the duration between the R wave of the ECG and the onset of obstruction (T1) was prolonged significantly (from 117 +/- 30 to 155 +/- 32 ms, P < 0.0001), and peak LVP was reduced significantly (from 222 +/- 42 to 177 +/- 39 mmHg, P < 0.0001). The relation between the prolongation of T1 and the percent reduction in peak LVP was predicted well by the theoretical equation (coefficient of determination R2 = 0.926). Our model simplifies the therapeutic strategy for reducing the left ventricular outflow pressure gradient in patients with HOCM, which is to delay the time of onset of obstruction by some methods.
Niki
K
K
Department of Cardiovascular Sciences, The Heart Institute of Japan, Tokyo Women's Medical University School of Medicine.
Sugawara
M
M
Tanino
S
S
Iwade
K
K
Hosoda
S
S
Kasanuki
H
H
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000494:pharmacology; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000188:drug therapy* / Q000503:physiopathology; D004206:Disopyramide / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012044:Regression Analysis; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects*; D014694:Ventricular Outflow Obstruction / Q000188:drug therapy* / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D004206:Disopyramide