Long-term effects of xamoterol on left ventricular diastolic function and late remodeling: A study in patients with anterior myocardial infarction and single-vessel disease

H. Pouleur, C. Van Eyll, C. Hanet, P. Cheron, A. A. Charlier, M. F. Rousseau

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Résumé

The purpose of the study was to examine whether the prolonged administration of the β1-adrenoceptor partial agonist xamoterol could improve left ventricular diastolic function and affect the global remodeling process of the left ventricle after anterior myocardial infarction. In 22 patients with anterior myocardial infarction and single-vessel disease, left ventricular angiography (+Millar) was performed under basal conditions 1 to 2 months after the active myocardial infarction. Eight patients were then treated for 3 months with placebo and 14 were treated with xamoterol (200 mg bid) and a second left ventricular angiographic study was performed. Angiograms were digitized frame by frame to derive the diastolic pressure-volume relationship and to compute wall stress. An index of elastic myocardial stiffness was computed at a constant stress of 30 kdynes/cm2 before and after treatment. To evaluate changes in left ventricular shape, segmental areas in anterior and inferior segments were computed and compared at end-diastole and end-systole. After xamoterol, left ventricular end-diastolic pressure and mean diastolic wall stress decreased (from 24 ± 5 to 15 ± 5 mm Hg and from 57 ± 32 to 38 ± 22 kdynes/cm2, respectively; both p < .01 vs baseline and vs placebo). These changes were accompanied by a downward shift in the diastolic pressure-volume relationship and by a decrease in the index of myocardial stiffness from 526 ± 270 to 371 ± 194 kdynes/cm2 (p < .02). Left ventricular shape was not significantly altered by xamoterol but a significant remodeling of the left ventricular silhouette was evident at end-systole, as indicated by an improvement in the ratio (anterior segmental area/inferior segmental area) from 1.14 to 1.02 (median values; p < .025 vs baseline and vs placebo). It is concluded that impaired diastolic function after myocardial infarction is not entirely caused by fibrotic scar tissue but also by some active alterations in the function of viable myocardial areas that can be improved by therapy with xamoterol. Further studies are needed to determine whether the improvement in diastolic function and the systolic left ventricular remodeling are directly related.

langue originaleAnglais
Pages (de - à)1081-1089
Nombre de pages9
journalCirculation
Volume77
Numéro de publication5
Les DOIs
Etat de la publicationPublié - 1 janv. 1988
Modification externeOui

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