Abstract
The effect of diltiazem on myocardial ischemia in patients with hypertrophic cardiomyopathy (HCM) was evaluated by exercise myocardial201Tl single photon emission computed tomography (SPECT). Exercise myocardial SPECT was performed before and 8 weeks after oral administration of diltiazem (180 mg/day) in 20 patients with HCM who showed transient perfusion defects on exercise myocardial201Tl SPECT under control conditions. SPECT images were divided into 17 segments. The201Tl perfusion defects were visually scored and evaluated as the defect score. The transient dilation index was calculated as an index of subendocardial ischemia. Improvement of the defect score was demonstrated in 15 patients after the administration of diltiazem. The mean defect score decreased significantly from 9.90± 5.17 to 5.50±4.89 (p < 0.0001). Although 16 of 20 patients showed an abnormal transient dilation index before diltiazem treatment, 16 showed improvement and 13 of these normalized after diltiazem therapy. The mean transient dilation index decreased from 1.16 + 0.10 to 1.02 ± 0.09 (p < 0.0001). In conclusion, diltiazem prevents or diminishes myocardial ischemia in patients with HCM.
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Cannon RO, Rosing DR, Maron BJ, Leon MB, Watson SE, Epstein SE. Myocardial ischemia in patients with hypertrophic cardiomyopathy. Contribution of inadequate vasodilator reserve and elevated left ventricular filling pressure.Circulation 71: 234–243, 1985.
Thompson DS, Naquvi N, Juul SM, Swanton RH, Coltart DJ, Jenkins BS, et al. Effects of propranolol on myocardial oxygen consumption, substrate extraction, and hemodynamics in hypertrophic obstructive cardiomyopathy.Br Heart 744:488–498, 1980.
Pitcher D, Wainwright R, Maisy M, Curry P, Sowton E. Assessment of chest pain in hypertrophic cardiomyopathy using exercise Thallium-201 myocardial scintigraphy.Br Heart J 44:650–656, 1980.
Hanrath P, Mathey DG, Montz R, Thiel U, Vorbringer H, Kupper W, et al. Myocardial Thallium-201 Imaging in Hypertrophie Obstructive Cardiomyopathy.Eur Heart J 2: 177–185, 1981.
Kenneth A, Morrison J, Padnick MB, Binder AJ, Chiaramiida S, Margouleff D, et al. Idiopathic hypertrophic subaortic stenosis: Evaluation of anginal symptoms with thallium-201 myocardial imaging.Am J Cardiol 44: 1040–1045, 1979.
O’Gara PT, Bonow RO, Maron BJ, Damske BA, Lingen AV, Bacharach SL, et al. Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: Assessment with thallium-201 emission computed tomography.Circulation 76: 1214–1223, 1987.
Udelson JE, Bonow RO, O’Gara PT, Maron BJ, Lingen AV, Bacharach SL, et al. Verapamil prevents silent myocardial perfusion abnormalities during exercise in asymptomatic patients with hypertrophic cardiomyopathy.Circulation 79: 1052–1060, 1989.
Toshima H, Koga Y, Nagata H, Toyomasu K, Itaya K, Matoba T. Comparable Effects of Oral Diltiazem and Verapamil in the Treatment of Hypertrophic Cardiomyopathy.Jpn Heart J 27: 701–715, 1986.
Nagao M, Yasue H, Omote S, Takizawa A, Hyon H, Nishida S, et al. Diltiazem-induced decrease of exercise-elevated pulmonary arterial diastolic pressure in hypertrophic cardiomyopathy patients.Am Heart J 102: 789–790, 1981.
Suwa M, Hirota Y, Kawamura K. Improvement in left ventricular diastolic function during intravenous and oral diltiazem in patients with hypertrophic cardiomyopathy: An echocardiographic study.Am J Cardiol 54: 1047–1053, 1984.
Sugihara H, Shiga K, Umamoto I, Harada Y, Katahira T, Nakagawa T, et al. Assessment of transient dilation of the left ventricular cavity in patients with hypertrophic cardiomyopathy by exercise Thallium-201 scintigraphy.KAKU IGAKU(Jpn J Nucl Med) 27: 1281–1289, 1990.
Dilsizian V, Bonow RO, Epstein SE, Fananapazir L. Myocardial ischemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophic cardiomyopathy.J Am Coll Cardiol 22: 796–804, 1993.
Taniguchi Y, Sugihara H, Ohtsuki K, Umamoto I, Nakagawa T, Shiga K, et al. Effect of verapamil on myocardial ischemia in patients with hypertrophic cardiomyopathy: Evaluation by exercise thallium-201 SPECT.J Cardiol 24: 45–51, 1994.
Cannon RO, Dilsizian V, O’Gara PT, Udelson JE, Schenke WH, Quyyumi A, et al. Myocardial metabolic, hemodynamic, and electrocardiographic significance of reversible thallium-201 abnormalities in hypertrophic cardiomyopathy.Circulation 83: 1660–1667, 1991.
Maron BJ, Wolfson JK, Epstein SE, Roberts WC. Intramural (“small vessel”) coronary artery disease in hypertrophic cardiomyopathy.J Am Coll Cardiol 8: 545–557, 1986.
Marcus ML, Harrison DG, Chilian WM, Koyanagi S, Inoue T, Tomanek RJ, et al. Alterations in the coronary circulation in hypertrophied ventricle.Circulation 75 (Suppl 1): 1–19, 1987.
Weiss MB, Ellis K, Sciacca RR, Johnson LL, Schmidt DH, Cannon PJ. Myocardial blood flow in congestive and hypertrophic cardiomyopathy, relationship to peak wall stress and mean velocity of circumferential fiber shortening.Circulation 54:484–494, 1976.
Factor SM, Minase T, Cho S, Dominitz R, Sonnenblick EH. Microvascular spasm in the cardiomyopathic Syrian hamster: A preventable cause of focal myocardial necrosis.Circulation 66: 342–354, 1982.
Hanrath P, Mathey DG, Kremer P, Sonntag F, Bleifeld W. Effect of verapamil on left ventricular isovolumic relaxation time and regional left ventricular filling in hyper-trophic cardiomyopathy.Am J Cardiol 45: 1258–1264, 1982.
Bonow RO. Effect of calcium-channel blocking agents on left ventricular diastolic function in hypertrophic cardiomyopathy and in coronary artery disease.Am J Cardiol 55: 172B-178B, 1985.
Weyrens FJ, Mooney J, Lesser J, Mooney MR. Intracoronary diltiazem for microvascular spasm after interventional therapy.Am J Cardiol 75: 849–850, 1995.
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Sugihara, H., Taniguchi, Y., Ito, K. et al. Effects of diltiazem on myocardial perfusion abnormalities during exercise in patients with hypertrophic cardiomyopathy. Ann Nucl Med 12, 349–354 (1998). https://doi.org/10.1007/BF03164924
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DOI: https://doi.org/10.1007/BF03164924