Circulation, Vol 88, 481-491, Copyright © 1993 by American Heart Association
H Pouleur, MF Rousseau, C van Eyll, L Stoleru, W Hayashida, JA Udelson, N Dolan, D Kinan, P Gallagher and S Ahn
BACKGROUND. The aim of the present study was to analyze the changes in left
ventricular diastolic function that occur in patients with chronic severe
left ventricular systolic dysfunction in the absence or presence of
prolonged therapy with an angiotensin converting enzyme inhibitor. METHODS
AND RESULTS. Left ventricular function data (cineangiography plus Millar,
frame-by-frame analysis) and right ventricular volumes (radionuclide
angiography) were obtained at baseline and after an average follow-up of
12.4 months in 42 patients with a left ventricular ejection fraction of 35%
or less. After baseline measurements, the patients were randomized to
placebo (n = 16) or enalapril (10 mg BID, n = 26). In the placebo group,
the changes in left ventricular function were characterized by increases in
end-diastolic (159 +/- 43 to 170 +/- 44 mL/m2) and end-systolic (119 +/- 38
to 128 +/- 49 mL/m2) volumes accompanied by a downward and rightward shift
of the diastolic pressure- volume relation. In contrast, decreases in
end-diastolic (166 +/- 43 to 156 +/- 47 mL/m2) and end-systolic (125 +/- 43
to 111 +/- 42 mL/m2) volumes accompanied by a slight upward and leftward
shift of the diastolic pressure-volume relation were noted in the enalapril
group. These changes in left ventricular volumes were significantly
different between groups (both P < .005) but were not attended by
changes in left ventricular end-diastolic pressure, in time constant of
isovolumic pressure decrease, or in right ventricular volumes. However, the
chamber stiffness constant beta decreased from 0.044 +/- 0.027 to 0.032 +/-
0.019 mL-1/m2 in the placebo group, whereas it increased insignificantly in
the enalapril group (0.040 +/- 0.028 to 0.041 +/- 0.028 mL-1/m2). These
changes in chamber stiffness constant beta between baseline and follow-up
were significantly different between placebo and enalapril groups (P <
.05). Another index of chamber compliance, delta V/delta P, also confirmed
the presence of opposite changes in left ventricular chamber compliance in
the placebo group and in the enalapril group. The mean diastolic wall
stress increased with placebo but not with enalapril (+51 versus -13
kdyn/cm2; P < .04) whereas left ventricular mass and the indexes of left
ventricular sphericity tended to improve in the enalapril group. The
changes in plasma levels of norepinephrine, atrial natriuretic peptide, and
arginine vasopressin were, however, comparable in both groups. CONCLUSIONS.
The data indicate that in patients with severe systolic left ventricular
dysfunction, the progressive left ventricular dilatation was accompanied by
a decrease in left ventricular chamber stiffness; enalapril therapy was
able to prevent or partially reverse these changes and tended to reduce
left ventricular mass and ventricular sphericity. Those changes were
suggestive of partial reversal of left ventricular remodeling by enalapril
administration.
ARTICLES
Effects of long-term enalapril therapy on left ventricular diastolic properties in patients with depressed ejection fraction. SOLVD Investigators
Division of Cardiology, University of Louvain, School of Medicine, Brussels, Belgium.
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