Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance

Setaro, John F.; Zaret, Barry L.; Schulman, Douglas S.; Black, Henry R.; Soufer, Robert

doi:10.1016/0002-9149(90)90937-v

Cited by 313 publications

(138 citation statements)

References 27 publications

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“…First, the reduction in the systolic blood pressure, in itself, may be associated with the improvement in left ventricular diastolic function as shown in VALIDD trial. 4,7,[13][14][15][16] In this study, the greater reduction in systolic blood pressure was associated with the greater increase in the e¢ velocity. Second, left ventricular systolic load may be reduced by attenuating the wave reflection.…”

Section: Impact Of Ccb On Diastolic Functionsupporting

confidence: 46%

Impact of azelnidipine treatment on left ventricular diastolic performance in patients with hypertension and mild diastolic dysfunction: multi-center study with echocardiography

et al. 2009

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, for the Clinical impact of Azelnidipine on Left VentricuLar diastolic function and OutComes in patients with hypertension (CALVLOC) trial investigators 7We investigated the impact of lowering blood pressure (BP) with azelnidipine, a newly developed calcium channel blocker, generation on the left ventricular (LV) diastolic function and LV filling pressure by assessing non-invasive indices derived from echo Doppler study. This study evaluated 232 hypertensive patients with diastolic dysfunction. This study had two groups: (1) in which azelnidipine was administered to patients as a first-line therapy, and (2) in which amlodipine was converted to azelnidipine. Early diastolic mitral annulus velocity (e¢, cm s À1 ), the ratio of peak E velocity to e¢ velocity (E/e¢ ratio) and level of brain natriuretic peptide (BNP) were measured before and, an average of, 8 months after azelnidipine treatment. In the first-line azelnidipine group, the systolic and diastolic BP reduced by 26 and 11 mm Hg, respectively. The e¢ increased, and E/e¢ ratio and BNP level decreased significantly. In the converted-from-amlodipine group, the systolic and diastolic BP decreased by 14 and 6 mmHg, respectively. The e¢ velocity increased, but the E/e¢ ratio and BNP level did not change. In both groups, azelnidipine lowered BP and improved LV diastolic function (an increase in the e¢ velocity). Possible reduction in LV filling pressure (a decrease in the E/e¢ ratio and BNP level) is observed only in the first-line azelnidipine group.

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Section: Impact Of Ccb On Diastolic Functionsupporting

confidence: 46%

Impact of azelnidipine treatment on left ventricular diastolic performance in patients with hypertension and mild diastolic dysfunction: multi-center study with echocardiography

et al. 2009

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“…16) A significant increase in exercise capacity and peak filling rate was observed after 5 weeks of therapy with verapamil as compared with placebo with no change in baseline systolic function and systolic blood pressure. Calcium channel blockers with negative chronotropic action such as verapamil or diltiazem may improve diastolic filling by the reduction in heart rate.…”

Section: Ca 2+ -Channel Blockersmentioning

confidence: 91%

Therapeutic Strategies for Diastolic Dysfunction: A Clinical Perspective

2009

J Cardiovasc Ultrasound

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I In nt tr ro od du uc ct ti io on nDespite the fact that up to 50% of heart failure patients have preserved left ventricular (LV) systolic function, treatment of diastolic heart failure remains largely empiric because there have been no large scale randomized trials evaluating the effects of specific pharmacological agents. Nonpharmacologic, pharmacologic and surgical approaches are available, although its efficacy has not been proven. Treatment should target the underlying pathological condition that causes the diastolic heart failure. For example, coronary artery disease, hypertensive heart disease, hypertrophic obstructive cardiomyopathy, and constrictive pericarditis provide relatively specific therapeutic targets, such as lowering of blood pressure, regression of hypertrophy and fibrosis, and treatment of ischemia, and a complete removal of constricting pericardium. Theoretically, pharmacological agents that facilitate myocardial relaxation and improve LV compliance would be ideal for the treatment of diastolic dysfunction. As a shortterm therapeutic goal, manipulation of the loading conditions (preload, afterload) and control of the heart rate will be crucial. The treatment of underlying condition (e.g. hypertension) should be the ultimate goal for the treatment of LV diastolic dysfunction. Many of the drugs used for the treatment of symptoms of heart failure due to diastolic dysfunction are similar to those of systolic dysfunction, although the rationale for their use, the pathophysiological process that is being altered by the drug, and the dosing regimen may be entirely different. In this review, several therapeutic modalities including pharmacologic, nonpharmacologic, and surgical approaches for primary diastolic heart failure will be discussed. P Ph ha ar rm ma ac co ol lo og gi ic c T Th he er ra ap py y Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockersACE-inhibitors and angiotensin II receptor blockers show not only an effect on blood pressure but elicit a direct effect on the myocardium via the local renin-angiotensin system. These effects are essential for the regression of LV hypertrophy, and the improvement in the elastic properties of the myocardium. 1)2) Several studies have documented that LV hypertrophy is more effectively reduced by ACE inhibitors than by other antihypertensive drugs, 3)4) suggesting an effect on myocardial structure beyond that provided by the reduction of pressure overload. Experimental and clinical studies suggest that the interaction of angiotensin II with its type 1 (AT1) receptors plays a critical role in alterations of collagen type I metabolism and development of myocardial fibrosis in arterial hypertension. Myocardial fibrosis is responsible for an increase in intrinsic myocardial stiffness that may alter the LV diastolic properties. Chronic activation of the reninangiotensin-aldosterone system has been shown to increase extracellular matrix fibrillar collagen and to be associated

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“…Therefore, CCBs have been considered as favorable drugs in diastolic HF in the past years. In two small scale studies, the rate-limiting CCB verapamil could improve exercise capacity and symptoms (240,241). Despite the lack of major randomized clinical trials relating this topic, a large registry study performed in hospitalized elderly patients was not able to show a change in total mortality or rate of HF hospitalization with prescriptions of CCBs, regardless the type of the CCB (242).…”

Section: Can Calcium Channel Blockers Be Used In Hf-pef?mentioning

confidence: 99%

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

Çavuşoğlu

Altay²,

Ekmekçi³

et al. 2015

Anatol J Cardiol

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Practical approaches for the treatment of chronic heart failure:Frequently asked questions, overlooked points and controversial issues in current clinical practiceHeart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature. (Anatol J Cardiol 2015: 15 Suppl 2; 1-60)

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Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance

Cited by 313 publications

References 27 publications

Impact of azelnidipine treatment on left ventricular diastolic performance in patients with hypertension and mild diastolic dysfunction: multi-center study with echocardiography

Impact of azelnidipine treatment on left ventricular diastolic performance in patients with hypertension and mild diastolic dysfunction: multi-center study with echocardiography

Therapeutic Strategies for Diastolic Dysfunction: A Clinical Perspective

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

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