The effect of verapamil on left ventricular remodelling and diastolic function after acute myocardial infarction (the Verapamil Infarction Study on Remodelling and Relaxation--VISOR).

The VISOR is a double blind, randomized, placebo-controlled study aimed to assess the effects of early and prolonged administration of verapamil on the left ventricular geometry and diastolic function in patients with anterior acute myocardial infarction treated with thrombolysis. Patients with heart failure or ejection fraction < 45% were excluded. Within 12 hours from starting thrombolysis, 70 patients were given verapamil (5 mg/hour intravenously for the first 24 hours, followed by 120 mg t.i.d. perorally for 6 months) or equivalent placebo. Echocardiograms were performed on admittance, before discharge, after 3 months and 6 months. The following parameters were calculated: left ventricular volumes, ejection fraction, sphericity index, early (E) and late (A) transmitral peak flow velocities and time-velocity integrals with their ratios, deceleration time and half-time of E, isovolumic relaxation time (IVRT), and non-invasive time constant of ventricular relaxation (tau). The basal and the last available parameters were considered for statistical analysis. The effects of the treatment on the left ventricular volumes, ejection fraction, and sphericity index were not statistically relevant. Conversely, a reduction of E/A ratio (P < .05) and increases of A integral (P < .01), deceleration time and half-time of E, IVRT and tau (P < .05) were found in the placebo group and not in the verapamil group. No significant changes in the blood pressure, heart rate, PQ interval, and biochemical parameters were observed in the two groups. In conclusion, in patients with a thrombolysed anterior acute myocardial infarction and preserved systolic function, verapamil can prevent alterations of the diastolic function in absence of effect on ventricular remodelling, and has a good safety profile.

[Kinetics of intravenously administered flecainide in patients with acute myocardial infarct]. / Cinetica della flecainide per via endovenosa in pazienti affetti da infarto miocardico acuto.

Flecainide (F) is a new antiarrhythmic agent recently introduced into clinical practice. The above study was aimed at evaluating its intravenous (iv) pharmacokinetics in patients (pts) with acute myocardial infarction (AMI) on 1st and 2nd day, complicated by complex ventricular premature beats (VPBs). 2 mg/kg F was given iv as bolus injection, followed by 300 mg/24 hrs iv infusion. Plasma F values were evaluated by HPLC. Plasma F levels increased progressively, in a non uniform but predictable manner: in pts with large AMI and cardiac failure, F plasma levels, although remaining within the therapeutic range, were greatly increased after the 2nd hour (P less than 0.05) in comparison with pts without cardiac insufficiency. Negative side effects, both cardiac and extracardiac, were not observed: F appeared a handy and effective agent in post-AMI arrhythmias, especially when plasma drug levels are controlled; plasma F level monitoring is anyway recommended in pts with cardiac failure, owing to the wide interindividual variations.