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An equation to predict the changes in peak left ventricular pressure in hypertrophic obstructive cardiomyopathy after treatment: Application to the administration of disopyramide

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Summary

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 (T 1) 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 ofT 1 and the percent reduction in peak LVP was predicted well by the theoretical equation (coefficient of determinationR 2 = 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.

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References

  1. Wigle ED, Rakowski H, Kimball BP, Williams WG (1995) Hypertrophic cardiomyopathy: clinical spectrum and treatment. Circulation 92:1680–1692

    PubMed  CAS  Google Scholar 

  2. Bonow RO, Maron BJ, Leon MB, Cannon RO III, Epstein SE (1988) Medical and surgical therapy of hypertrophic cardiomyopathy. Cardiovasc Clin 19:221–239

    PubMed  CAS  Google Scholar 

  3. Cannon RO III, McIntosh CL, Schenke WH, Maron BJ, Bonow RO, Epstein SE (1989) Effect of surgical reduction of left ventricular outflow obstruction on hemodynamics, coronary flow, and myocardial metabolism in hypertrophic cardiomyopathy. Circulation 79:766–775

    PubMed  Google Scholar 

  4. Pollick C, Rakowski H, Wigle ED (1984) Muscular subaortic stenosis: the quantitative relationship between systolic anterior motion and the pressure gradient. Circulation 69:43–49

    PubMed  CAS  Google Scholar 

  5. Pollick C, Morgan CD, Gilbert BW, Rakowski H, Wigle ED (1982) Muscular subaortic stenosis: the temporal relationship between systolic anterior motion of the anterior mitral leaflet and the pressure gradient. Circulation 66:1087–1094

    PubMed  CAS  Google Scholar 

  6. Pollick C (1982) Muscular subaortic stenosis: hemodynamic and clinical improvement after disopyramide. N Engl J Med 307:997–999

    Article  PubMed  CAS  Google Scholar 

  7. Pollick C, Kimball B, Henderson M, Wigle ED (1988) Disopyramide in hypertrophic cardiomyopathy: I. Hemodynamic assessment after intravenous administration. Am J Cardiol 62:1248–1251

    Article  PubMed  CAS  Google Scholar 

  8. Duncan WJ, Tyrrell MJ, Bharadwaj BB (1991) Disopyramide as a negative inotrope in obstructive cardiomyopathy in children. Can J Cardiol 7:81–86

    PubMed  CAS  Google Scholar 

  9. Kimball BP, Bui S, Wigle ED (1993) Acute dose-response effects of intravenous disopyramide in hypertrophic obstructive cardiomyopathy. Am Heart J 125:1691–1697

    Article  PubMed  CAS  Google Scholar 

  10. Niki K, Sugawara M, Asano R, Oka T, Kondoh Y, Tanino S, Iwade K, Magosaki N, Kasanuki H, Hosoda S (1997) Disopyramide improves the balance between myocardial oxygen supply and demand in patients with hypertrophic obstructive cardiomyopathy. Heart Vessels 12:111–118

    PubMed  CAS  Google Scholar 

  11. Thompson DS, Naqvi N, Juul SM, Swanton RH, Coltart DJ, Jenkins BS, Webb-Peploe MM (1980) Effects of propranolol on myocardial oxygen consumption, substrate extraction, and haemodynamics in hypertrophic obstructive cardiomyopathy. Br Heart J 44:488–498

    PubMed  CAS  Google Scholar 

  12. Suga H, Sagawa K, Shoukas AA (1973) Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circ Res 32:314–322

    PubMed  CAS  Google Scholar 

  13. Suga H, Sagawa K, Demer L (1980) Determinants of instantaneous pressure in canine left ventricle: time and volume specification. Circ Res 46:256–263

    PubMed  CAS  Google Scholar 

  14. Murgo JP, Alter BR, Dorethy JF, Altobelli SA, McGranahan GM Jr (1980) Dynamics of left ventricular ejection in obstructive and nonobstructive hypertrophic cardiomyopathy. J Clin Invest 66:1369–1382

    Article  PubMed  CAS  Google Scholar 

  15. Pak PH, Maughan WL, Baughman KL, Kass DA (1996) Marked discordance between dynamic and passive diastolic pressure-volume relations in idiopathic hypertrophic cardiomyopathy. Circulation 94:52–60

    PubMed  CAS  Google Scholar 

  16. Stewart WJ, Schiavone WA, Salcedo EE, Lever HM, Cosgrove DM, Gill CC (1987) Intraoperative Doppler echocardiography in hypertrophic cardiomyopathy: correlations with the obstructive gradient. J Am Coll Cardiol 10:327–335

    PubMed  CAS  Google Scholar 

  17. Maron BJ, Gottdiener JS, Arce J, Rosing DR, Wesley YE, Epstein SE (1985) Dynamic subaortic obstruction in hypertrophic cardiomyopathy: analysis by pulsed Doppler echocardiography. J Am Coll Cardiol 6:1–15

    Article  PubMed  CAS  Google Scholar 

  18. Wigle ED, Marquis Y, Auger P (1967) Muscular subaortic stenosis: initial left ventricular inflow tract pressure in the assessment of intraventricular pressure differences in man. Circulation 35:1100–1117

    PubMed  CAS  Google Scholar 

  19. Hanya S (1989) Idiopathic hypertrophic subaortic stenosis: analysis using a multisensor catheter. In: Sugawara M, Kajiya F, Kitabatake A, Matsuo H (eds) Blood flow in the heart and large vessels. Springer, Berlin Heidelberg New York Tokyo, pp 120–123

    Google Scholar 

  20. Pierce GE, Morrow AG, Braunwald E (1964) Idiopathic hypertrophic subaortic stenosis: III. Intraoperative studies of the mechanism of obstruction and its hemodynamic consequences. Circulation 30 (suppl 4):152–213

    PubMed  Google Scholar 

  21. Brutsaert DL, Sys SU (1989) Relaxation and diastole of the heart. Physiol Rev 69:1228–1315

    PubMed  CAS  Google Scholar 

  22. Glantz SA, Slinker BK (1990) Primer of applied regression and analysis of variance. McGraw-Hill, New York, pp 35–36

    Google Scholar 

  23. Harrison DC, Braunwald E, Glick G, Mason DT, Chidsey CA, Ross J Jr (1964) Effects of beta adrenergic blockade on the circulation, with particular reference to observations in patients with hypertrophic subaortic stenosis. Circulation 29:84–98

    PubMed  CAS  Google Scholar 

  24. Millaire A, Goullard L, Decoulx E, deGroote P, Houdas Y, Ducloux G (1992) Efficiency of disopyramide in hypertrophic cardiomyopathy during stress states. Am J Cardiol 69:423–424

    Article  PubMed  CAS  Google Scholar 

  25. Kass DA, Maughan WL, Guo ZM, Kono A, Sunagawa K, Sagawa K (1987) Comparative influence of load versus inotropic status on indexes of ventricular contractility: experimental and theoretical analysis based on pressurevolume relationships. Circulation 76:1422–1436

    PubMed  CAS  Google Scholar 

  26. Naqvi N, Thompson DS, Morgan WE, Williams BT, Coltart DJ (1979) Haemodynamic effects of disopyramide in patients after open-heart surgery. Br Heart J 42:587–594

    PubMed  CAS  Google Scholar 

  27. Koetter V, Linderer T, Schroeder R (1980) Effects of disopyramide on systemic and coronary hemodynamics and myocardial metabolism in patients with coronary artery disease: comparison with lidocaine. Am J Cardiol 46:469–475

    Article  CAS  Google Scholar 

  28. McDonald K, McWilliams E, O'Keeffe B, Maurer B (1988) Functional assessment of patients treated with permanent dual chamber pacing as a primary treatment for hypertrophic cardiomyopathy. Eur Heart J 9:893–898

    PubMed  CAS  Google Scholar 

  29. Jeanrenaud X, Goy JJ, Kappenberger L (1992) Effects of dual-chamber pacing in hypertrophic obstructive cardiomyopathy. Lancet 339:1318–1323

    Article  PubMed  CAS  Google Scholar 

  30. Endresen K, Amlie JP, Forfang K (1988) Effects of disopyramide on repolarisation and interventricular conduction in man. Eur J Clin Pharmacol 35:467–474

    Article  PubMed  CAS  Google Scholar 

  31. Lee JK, Takanaka C, Nonokawa M, Kato H, Yabe S, Kodama I, Toyama J (1995) Complex frequencydependent interaction of class-I antiarrhythmic drugs as they affect intraventricular conduction. Eur Hear J 16:832–841

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan

    Kiyomi Niki & Motoaki Sugawara

  2. Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan

    Shunsuke Tanino, Kazunori Iwade & Hiroshi Kasanuki

  3. Sakakibara Heart Institute, 2-5-4 Yoyogi, Shibuya-ku, 151-0053, Tokyo, Japan

    Saichi Hosoda

Authors
  1. Kiyomi Niki
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  2. Motoaki Sugawara
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  3. Shunsuke Tanino
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  4. Kazunori Iwade
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  5. Saichi Hosoda
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  6. Hiroshi Kasanuki
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Additional information

K.N. and M.S. were supported by Grants-in-Aid for Scientific Research (C)(2)-096707762 and (C)(2)-09680866 from the Ministry of Education, Science, Sports and Culture of Japan. M.S. is grateful for the support of Nakatani Electronic Measuring Technology Association of Japan.

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Niki, K., Sugawara, M., Tanino, S. et al. An equation to predict the changes in peak left ventricular pressure in hypertrophic obstructive cardiomyopathy after treatment: Application to the administration of disopyramide. Heart Vessels 14, 72–81 (1999). https://doi.org/10.1007/BF02481746

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  • DOI: https://doi.org/10.1007/BF02481746

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