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 µg/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.