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Heart and Vessels

, Volume 11, Issue 6, pp 303–309 | Cite as

Improvement of left ventricular diastolic dysfunction in hypertensive patients 1 month after ACE inhibition therapy: Evaluation by ultrasonic automated boundary detection

  • N. Angomachalelis
  • A. I. Hourzamanis
  • S. Sideri
  • E. Serasli
  • Chr Vamvalis
Originals

Summary

The purpose of this study was to detect any improvement in left ventricular diastolic dysfunction in hypertensive patients 1 month after cilazapril therapy. Twenty-three patients, 5 men and 18 women (mean age, 53.52 ± 9.10 years), with mild or moderate hypertension (160 ± 13/98 ± 10mm Hg), and free of other cardiac or systemic diseases, were studied using ultrasonic automated boundary detection (ABD) and pulsed Doppler echocardiography, before and 1 month after a daily dose of 2.5 mg of cilazapril. The following new ABD diastolic indices were determined: the time rate of area change in early diastole (dA/dt)E, that in late diastole (dA/dt)A, and their ratio (dA/dt)E/(dA/dt)A, while Doppler transmitral flow measurements of left ventricular diastolic filling were also simultaneously recorded. The ABD results showed left ventricular diastolic dysfunction (LVDD) in 9 of 23 patients (39%) compared with the ABD values of 12 normal volunteers. Neither method revealed any significant difference before and after treatment in the patient group as a whole. However, in the group of 9 patients with diastolic dysfunction, the ABD ratio (dA/dt)E/(dA/dt)A was significantly improved after cilazapril therapy (1.20 ± 0.21 versus 1.41 ± 0.17;P < 0.05). We concluded that a large percentage (39%) of patients with mild or moderate hypertension had reduced diastolic performance of the left ventricle at a stage of the disease when systolic dysfunction and/or hypertrophy were not evident. Significant improvement of diastolic dysfunction in hypertensive patients could be detected by the proposed ABD new diastolic indices 1 month after cilazapril therapy. In conclusion, automatic boundary detection should be a useful non-invasive modality for the early diagnosis of left ventricular diastolic dysfunction, as well as early recognition of its improvement.

Key words

Hypertension LV function LV diastolic dysfunction Angiotensin-converting enzyme (ACE) inhibition therapy Automatic boundary detection Acoustic quantification 

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References

  1. 1.
    Spirito P, Maron BJ (1988) Doppler echocardiography for assessing left ventricular function. Ann Intern Med 109:122–126Google Scholar
  2. 2.
    Rokey R, Kuo LC, Zoghbi WA, Limacher MC, Quinones MA (1985) Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography. Circulation 71:543–550Google Scholar
  3. 3.
    Spirito P, Maron BJ, Bonow RO (1986) Noninvasive assessment of left ventricular diastolic function: Comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques. J Am Coll Cardiol 7:518–526Google Scholar
  4. 4.
    Phillips RA, Goldman ME, Ardeljan M, Arora R, Eison HB, Yu BY, Krakoff LR (1989) Deter-minants of abnormal left ventricular filling in early hypertension. J Am Coll Cardiol 14:979–985Google Scholar
  5. 5.
    Phillips RA, Coplan NL, Krakoff LR, Yeager K, Ross RS, Gorlm R, Goldman ME (1987) Doppler echocardiographic analysis of left ventricular filling in treated hypertensive patients. J Am Coll Cardiol 9:317–322Google Scholar
  6. 6.
    Dennolle T, Julien J, Jeunemaitre X, Dibold B, Pluin P, Corvol P (1989) Left ventricular diastolic function in hypertension: Relationship with hypertrophy (abstract). XIth Congress of the European Society of Cardiology, Nice 1989. Eur Heart J 10:642Google Scholar
  7. 7.
    Bryg RJ, Williams GA, Labovitz AJ (1987) Effect of ageing on left ventricular diastolic filling in normal subjects. Am J Cardiol 59:971–974Google Scholar
  8. 8.
    Tajik A, Seward JB, Hagler DJ, Mair DD, Lie JT (1978) Two-dimensional real-time ultrasonic imaging of the heart and great vessels: Technique, image orientation, structure, identification and validation. Mayo Clin Proc 53:271–303Google Scholar
  9. 9.
    Quinones MA, Wagoner AD, Reduto LA, Nelson JG, Young JB, Winters WL, Ribeiro LG, Miller RR (1981) A new simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation 64:744–753Google Scholar
  10. 10.
    Stoddard MF, Pearson AC, Kern MJ, Ratcliff J, Mrosek DJ, Labovitz AJ (1989) Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation 79:1226–1236Google Scholar
  11. 11.
    Triulzi MD, Castini D, Ornaghi M, Vitolo E (1990) Effects of preload reduction on mitral flow velocity pattern in normal subjects. Am J Cardiol 66:995–1001Google Scholar
  12. 12.
    Appleton CP, Hatle LK (1992) The natural history of left ventricular filling abnormalities: Assessment by twodimensional and Doppler echocardiography. Echocardiography 9:437–457Google Scholar
  13. 13.
    Taylor R, Waggoner AD (1992) Doppler assessment of left ventricular diastolic function: A review. J Am Soc Echocardiogr 5:603–612Google Scholar
  14. 14.
    Perez JE, Waggoner AD, Barzilai B, Melton HE, Miller JG, Sobel BE (1992) On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging. J Am Coll Cardiol 19:313–320Google Scholar
  15. 15.
    Hewlett Packard (1991) HP SONOS phased array imaging system users guide: Acoustic quantification, 1st edn. Andover, Mass.Google Scholar
  16. 16.
    Labovitz AJ, Pearson AC (1987) Evaluation of left ventricular diastolic function: Clinical relevance and recent Doppler echocardiographic insights. Am Heart J 114:836–851Google Scholar
  17. 17.
    Hourzamanis A, Angomachalelis N, Louridas G, Spanos P (1993) Pre and postoperative assessment of left ventricular diastolic function by pulsed Doppler echocardiography in coronary artery disease (abstract). XVIIth World Congress on Diseases of the chest, Amsterdam 1993. Chest 103 (Suppl 3):2075Google Scholar
  18. 18.
    Angomachalelis N, Hourzamanis A, Vakalis D, Vamvalis C, Serasli E, Siurthas D (1994) Acoustic quantification: new diastolic indices of left ventricular function in hypertension. Correlation with Doppler echocardiography. Postgrad Med J 70 (Suppl 1):57–66Google Scholar
  19. 19.
    Maron BJ, Spirito P, Green CJ, Wesleg KJ, Bonow RO, Arce J (1987) Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 10:733–742Google Scholar
  20. 20.
    Angomachalelis N, Hourzamanis A, Vamvalis C, Gavrielidis A (1992) Doppler evaluation of left ventricular diastolic function in patients with systemic sarcoidosis. Postgrad Med J 68 (Suppl 1):52–56Google Scholar
  21. 21.
    Takenaka K, Dabestani A, Gardin JM, Russell D, Clark S, Allfie A, Henry WL (1986) Pulsed Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy. Am J Cardiol 58:143–147Google Scholar
  22. 22.
    Azevedo J, Arroja P, Carmona J, Marques J, Araujo VP (1992) Left ventricular mass and Doppler diastolic function in hypertension. 14th Scientific Meeting of the International Society of Hypertension, Madrid 1992. J Hypertens 10 (Suppl 4):181Google Scholar
  23. 23.
    Haberbosch W, Desimone R, Dietz R, Waas W, Tillmanns H, Kubler W (1991) Improvement of diastolic filling in hypertensive patients treated with cilazapril. J Cardiovasc Pharmacol 17 (Suppl 2):S159-S162Google Scholar
  24. 24.
    Bielen E, Fagard R, Amery A (1992) Comparative study of the effects of isradipine and lisinopril-based treatment on cardiac structure and function. 14th Scientific Meeting of the International Society of Hypertension, Madrid 1992. J Hypertens 10 (Suppl 4):185Google Scholar
  25. 25.
    Picca M, Pelosi GC (1992) Effects of enalapril and amlodipine on left ventricular hypertrophy and function in hypertension (abstract). XIVth Congress of the European Society of Cardiology, Barcelona 1992. Eur Heart J 13:1056Google Scholar
  26. 26.
    Shahi M, Thom S, Poulter N, Sever PS, Foale RA (1990) Regression of left ventricular hypertrophy is not associated with improvement in left ventricular filling (abstract). XIIth Congress of the European Society of Cardiology, Stockholm 1990. Eur Heart J 11:1386.Google Scholar
  27. 27.
    Weber KT (1989) Cardiac interstitium in health and disease: The fibrilar collagen network. J Am Coll Cardiol 13:1637–1652Google Scholar
  28. 28.
    Weber KT, Brilla CG, Janicki JS (1990) Structural remodelling of myocardial collagen in systemic hypertension: Functional consequences and potential therapy. Heart Failure 6:129–137Google Scholar
  29. 29.
    Weber KT, Janicki JS, Pick R, Capasso J, Anversa P (1990) Myocardial fibrosis and pathologic hypertrophy in the rat with renovascular hypertension. Am J Cardiol 65:1G–7GGoogle Scholar
  30. 30.
    Waggoner AD, Perez JE, Barzilai B, Melton HE, Miller JG, Sobel BE (1991) Real-time two dimensional derived left ventricular diastolic and systolic areas and fractional area change using automatic boundary detection (abstract). J Am Soc Echocardiogr 4:304Google Scholar
  31. 31.
    Marcus R, Betnarz J, Coulden R, Shroff S, Lipton M, Lang R (1993) Ultrasonic backscatter system for automated on-line endocardial boundary detection: Evaluation by ultrafast computed tomography. J Am Coll Cardiol 22:839–847Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • N. Angomachalelis
    • 1
  • A. I. Hourzamanis
    • 1
  • S. Sideri
    • 1
  • E. Serasli
    • 1
  • Chr Vamvalis
    • 1
  1. 1.Department of Internal Medicine, “G. Papanikolaou” General Regional HospitalAristotle University School of MedicineThessaloniki, MacedoniaGreece

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