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Influence of propranolol infusion on cyclic variation of myocardial integrated backscatter in hypertrophic obstructive cardiomyopathy.

Abstract
It has been demonstrated that cyclic variation, assessed by myocardial integrated backscatter, reflects regional myocardial contractile function. The aim of this study was to investigate the influence of administration of beta-blocker propranolol on cyclic variation in patients with hypertrophic cardiomyopathy and persistent left ventricular (LV) pressure gradient and to test the hypothesis that the reduction of LV pressure gradient would be related to the change in regional contractile function. Before and after 2 mg propranolol infusion, transthoracic echocardiography with integrated backscatter analysis was performed on 11 patients (8 men and 3 women, mean age 54 +/- 12 years old). Integrated backscatter curves were obtained from the ventricular septum and LV posterior walls. With propranolol infusion, there was a significant reduction of LV fractional shortening (0.39 +/- 0.08 to 0.34 +/- 0.09, P <.01) and LV pressure gradient (83 +/- 40 mm Hg to 42 +/- 32 mm Hg, P <.001). In the posterior wall, the magnitude of cyclic variation significantly decreased (7.1 +/- 2.2 dB to 5.6 +/- 1.8 dB, P <.01), whereas in the septum, no apparent change in this parameter was observed (5.8 +/- 2.1 dB to 4.7 +/- 1.9 dB). Our findings suggest that in this form of cardiomyopathy, (1) the posterior wall myocardium is more susceptible to negative inotropic effects than the septum; (2) the reduction of LV pressure gradient is not related to that of regional wall motion; and (3) poor response of the ventricular septum is possibly because of more severe myocardial disarray and hypertrophy.
AuthorsTakahide Ito, Michihiro Suwa, Ayaka Kobashi, Tomomi Nakamura, Sadae Miyazaki, Makoto Imai, Yasushi Kitaura
JournalJournal of the American Society of Echocardiography : official publication of the American Society of Echocardiography (J Am Soc Echocardiogr) Vol. 15 Issue 10 Pt 2 Pg. 1251-5 (Oct 2002) ISSN: 0894-7317 [Print] United States
PMID12411913 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Adrenergic beta-Antagonists
  • Propranolol
Topics
  • Adrenergic beta-Antagonists (administration & dosage)
  • Adult
  • Aged
  • Blood Pressure (drug effects, physiology)
  • Cardiomyopathy, Hypertrophic (drug therapy, physiopathology)
  • Echocardiography
  • Female
  • Heart Rate (drug effects, physiology)
  • Heart Ventricles (diagnostic imaging, drug effects)
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Myocardial Contraction (drug effects, physiology)
  • Propranolol (administration & dosage)
  • Treatment Outcome
  • Ventricular Function, Left (drug effects, physiology)

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