Effects of perhexiline on myocardial deformation in patients with ischaemic left ventricular dysfunction

Background: Perhexiline improves functional capacity in heart failure, but the mechanisms are undefined. We sought its effects on myocardial deformation in patients with viable myocardium. Methods: Thirty-six medically-treated patients, stable at least 6 months post-infarction with LV dysfunction and myocardial viability shown by dobutamine echo (DbE) were randomised to receive perhexiline or matching placebo for 1 year. Cardiopulmonary exercise testing and DbE were performed at baseline and follow-up. Peak-systolic strain (S) and strain rate (SR) were measured offline in 111 dysfunctional segments in the placebo and 88 in the treatment group at rest, low-dose (LDD) and peak-dose dobutamine (PDD). Results: The serum perhexiline level was 0.27 +/- 0.7 mu g/l. There was no difference in the wall motion response to dobutamine at baseline and follow-up. Resting strain and SR were similar in the two groups at baseline and follow-up. However, SR at LDD and PDD increased in the placebo group and worsened during the same period in the perhexiline group. Patients on perhexiline and placebo had a similar rate-pressure product and exercise duration at baseline (7.9 +/- 2.7 vs 8.7 +/- 3.3 min, p = NS) and follow-up (9.6 +/- 4.6 vs 10.1 +/- 3.03 min, p = NS). Conclusion: Perhexiline does not improve the deformation of abnormal myocardial segments in patients with ischaemic LV dysfunction. (C) 2009 Published by Elsevier Ireland Ltd.