Effects of perhexiline on myocardial deformation in patients with ischaemic left ventricular dysfunction.
BACKGROUND
Perhexiline improves functional capacity in heart failure, but the mechanisms are undefined. We sought its effects on myocardial deformation in patients with viable myocardium.


METHODS
Thirty-six medically-treated patients, stable at least 6 months post-infarction with LV dysfunction and myocardial viability shown by dobutamine echo (DbE) were randomised to receive perhexiline or matching placebo for 1 year. Cardiopulmonary exercise testing and DbE were performed at baseline and follow-up. Peak-systolic strain (S) and strain rate (SR) were measured offline in 111 dysfunctional segments in the placebo and 88 in the treatment group at rest, low-dose (LDD) and peak-dose dobutamine (PDD).


RESULTS
The serum perhexiline level was 0.27+/-0.7 microg/l. There was no difference in the wall motion response to dobutamine at baseline and follow-up. Resting strain and SR were similar in the two groups at baseline and follow-up. However, SR at LDD and PDD increased in the placebo group and worsened during the same period in the perhexiline group. Patients on perhexiline and placebo had a similar rate-pressure product and exercise duration at baseline (7.9+/-2.7 vs 8.7+/-3.3 min, p=NS) and follow-up (9.6+/-4.6 vs 10.1+/-3.03 min, p=NS).


CONCLUSIONS
Perhexiline does not improve the deformation of abnormal myocardial segments in patients with ischaemic LV dysfunction.
Department of Medicine, University of Queensland, Brisbane, Australia.
Manish
M
Bansal
Jonathan
J
Chan
Rodel
R
Leano
Peter
P
Pillans
John
J
Horowitz
Thomas H
TH
Marwick
D000368:Aged; D002316:Cardiotonic Agents; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004280:Dobutamine; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D010480:Perhexiline / Q000008:administration & dosage* / Q000009:adverse effects; D010919:Placebos; D017211:Treatment Failure; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D010919:Placebos; D004280:Dobutamine; D010480:Perhexiline