USEFULNESS OF VERAPAMIL FOR CONGESTIVE-HEART-FAILURE ASSOCIATED WITH ABNORMAL LEFT-VENTRICULAR DIASTOLIC FILLING AND NORMAL LEFT-VENTRICULAR SYSTOLIC PERFORMANCE

Normal left ventricular systolic performance with impaired left ventricular diastolic filling may be present in a substantial number of patients with congestive heart failure (CHF). To evaluate the effect of oral verapamil in this subset, 20 men (mean age 68 ± 5 years) with CHF, intact left ventricular function (ejection fraction >45%) and abnormal diastolic filling (peak filling rate <2.5 end-diastolic volumes per second [edv/s]) were studied in a placebo-controlled, double-blind 5-week crossover trial. All patients underwent echocardiography to rule out significant valvular disease, and thallium-201 stress scintigraphy to exclude major active ischemia. Compared to baseline values, verapamil significantly improved exercise capacity by 33% (13.9 ± 4.3 vs 10.7 ± 3.4 minutes at baseline) and peak filling rate by 30% (2.29 ± 0.54 vs 1.85 ± 0.45 edv/s at baseline) (all p < 0.05). Placebo values were 12.3 ± 4.0 minutes and 2.16 ± 0.48 edv/s, respectively (difference not significant for both). Improvement from baseline in an objective clinicoradiographic heart failure score (scale 0 to 13) was significantly greater with verapamil compared to placebo (median improvement in score: 3 vs 1, p < 0.01). Mean ejection fraction and systolic blood pressure were unchanged from baseline; diastolic blood pressure and heart rate decreased to a small degree. Verapamil may have therapeutic efficacy in patients with CHF, preserved systolic function and impaired diastolic filling. © 1990.