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Effects of intravenous verapamil on left ventricular systolic function and diastolic filling dynamics in patients with coronary artery disease: Analysis of intramyocardial markers

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Summary

Left ventricular (LV) intramyocardial markers (MM) were used to study the effects of intravenous verapamil on LV pump function and diastolic filling dynamics. Verapamil (0.1 mg/kg bolus followed by 0.005 mg/kg/min) was administered to 10 patients with severe coronary artery disease 4 years after coronary bypass grafting and implantation of 7 tantalum markers into the LV. MM were filmed at 100 frames/sec (biplane 30° RAO/60° LAO). The digitized biplane MM coordinates were transformed into 3-dimensional coordinates and maximal projection area was defined. LV volumes were calculated frame-by-frame and ejection fraction and peak filling rate derived. Pressure-volume relations were calculated in early-, mid-, and end-diastole.

Verapamil caused a slight rise in end-diastolic pressure (12 to 14 mmHg, p<0.001) and end-diastolic volume (142 to 152 ml; p<0.005) and a fall in max dP/dt (1732 to 1570 mmHg/s; p<0.01) reflecting the drug's negative inotropic action. Verapamil reduced LV systolic pressure (136 to 126 mmHg; p<0.01), diastolic aortic pressure (74 to 68 mmHg; p<0.001) and peripheral resistance (1496 to 1348 dynes · s · cm−5; p<0.025); cardiac index was increased (2.7 to 2.91/min/m2; p<0.05), as were ejection fraction (47 to 49%; p<0.02) and stroke volume (67 to 75 ml; p<0.001). Great cardiac vein flow increased as well (88 to 102 ml/min; p<0.005). T, an index of relaxation, remained unchanged (63 to 62 ms) and the diastolic pressure-volume curve was shifted on the control curve upwards. Peak filling rate, however, was enhanced (269 to 334 ml/s; p<0.005).

It is concluded, that the depressant action of verapamil on the myocardium is compensated by LV unloading. Verapamil improves early diastolic filling, but has little effect on relaxation and diastolic distensibility of the LV. This improvement in diastolic filling appears to be related to alterations in loading conditions.

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Authors and Affiliations

  1. Department of Medicine Division of Cardiology, Medical University Hannover, D-3000, Hannover 61, F.R.G.

    Ivo Amende MD, R. Simon, A. Seegers, W. P. Hood Jr. & H. -D. Schmittenkoetter

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  1. Ivo Amende MD
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  2. R. Simon
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  3. A. Seegers
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  4. W. P. Hood Jr.
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  5. H. -D. Schmittenkoetter
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Additional information

A portion of this work was performed while Dr. Schmittenkoetter was a visiting Professor of the Medical Institute of Krottenbrunn.

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Amende, I., Simon, R., Seegers, A. et al. Effects of intravenous verapamil on left ventricular systolic function and diastolic filling dynamics in patients with coronary artery disease: Analysis of intramyocardial markers. Int J Cardiac Imag 3, 169–176 (1988). https://doi.org/10.1007/BF01814890

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