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

Lack of effect of perhexiline in ischaemic heart failure

“…Why did Bansal et al [1] get different results from Lee et al [8]. The latter studied patients with more severe heart failure treated for a shorter period, but we do not know whether this accounts for the difference.…”

“…The latter studied patients with more severe heart failure treated for a shorter period, but we do not know whether this accounts for the difference. Bansal et al [1] point to technical differences in the echocardiographic methods, which we are not competent to comment upon. The most likely reason to us is the fact that Lee et al [8] studied patients with anginal pain, whereas Bansal et al [1] only studied patients without anginal pain but having chronic ishaemia-induced viable myocardium.…”

“…Bansal et al [1] point to technical differences in the echocardiographic methods, which we are not competent to comment upon. The most likely reason to us is the fact that Lee et al [8] studied patients with anginal pain, whereas Bansal et al [1] only studied patients without anginal pain but having chronic ishaemia-induced viable myocardium. In the case of angina, i.e., transient ischaemia that resolves, a switch from FFA as substrate to glucose can be beneficial becausethelactateandprotonscanbewashedoutwhentheischaemiais relieved.…”

“…The editor is to be congratulated for publishing the paper in this issue by Bansal et al [1] in which they report the results of a clinical trial of perhexiline. In this study patients were recruited if they had reversible ischaemic myocardium and heart failure, but no anginal pain.…”

“…Alternatively, one could say that the stress test in Bansal et al's [1] patients induced "silent angina". The mechanism of such painless ischaemia is that the ischaemic myocardium is chronically denervated.…”