Abstract

Introduction

Materials & Methods

Results

Discussion & Conclusion

References

Discussion
Board

The study groups were well matched at baseline (Table 1). Nitrate and standard therapy-randomized patients did not initially differed in terms of clinical, echocardiographic or Doppler-derived parameters.

Table 1. Baseline characteristics of patients with standard therapy versus those with nitrate plus standard therapy.

Data expressed as mean value +/- SD or percent of patients. Between-group comparisons of baseline variables were not significant. NYHA, New York Heart Association; PE/PA ratio, ratio of early wave to atrial wave peak velocity.

All patients were followed until the end of the study. The NYHA functional class improved from 2.79+/-0.41 to 2.04+/-0.75 after 6 months of nitrate therapy (p=0.000), whereas no significant change was seen in the standard therapy group (baseline, 2.7+/-0.47 vs. 2.52+/-0.73 at 6 months, p=0.213, p=0.031 vs. nitrate therapy). In the nitrate group there was a significant increase in 6-minute walk test distance (baseline, 205+/-70 vs. 274+/-102 m at 6 months, p=0.000) compared with the standard therapy group (baseline, 206+/-114 vs. 212+/-100 m at 6 months, p=0.711; p=0.042 vs. nitrate therapy). Heart rate, systolic and diastolic arterial pressures were not significantly different between nitrate and standard therapy groups at baseline and at 6 months. Nitrate therapy caused a greater reduction in left atrial size (baseline, 51+/-6 vs. 45+/-4 mm at 6 months, p=0.000) than standard therapy (baseline, 51+/-6 vs. 48+/-5 mm at 6 months, p=0.37; p=0.032 vs. nitrate therapy).

Table 2 lists echocardiographic and Doppler-derived parameters at baseline and after 6 months ot therapy in both groups.

Table 2. Changes in echocardiographic and Doppler-derived parameters over time

Data expressed as mean value +/- SD or percent of patients. LVEDV, left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; LVEF, left ventricular ejection fraction; PE, peak velocity of early filling; PA, peak velocity of atrial filling; PE/PA ratio, ratio of early wave to atrial wave peak velocity; DT, deceleration time of early filling.

No between-group significant differences in echocardiographic parameters of LV remodeling and systolic function were seen after the treatment, whereas there were signs of a less restrictive pattern of LV filling in the nitrate group in terms of changes in Doppler-derived indices of LV diastolic filling. The PE/PA ratio decreased compared with the standard therapy group, and the PA wave velocity and deceleration time of early filling increased. At baseline, all patients had a restrictive pattern of LV filling. At the 6 months evaluation, mitral velocity filling patterns changed in 16 patients in the nitrate group and only in 7 patients in the standard therapy group (p=0.028).

At baseline, 14 of 24 (58%) patients in the nitrate group and 19 of 23 (83%) patients in the standard therapy group exhibited mitral regurgitation. Nitrate therapy produced a significant decrease in the degree of mitral regurgitation (baseline, 1.4+/-1.3 vs. 1.0+/-1.2 at 6 months, p=0.009) compared with standard therapy (baseline, 1.6+/1.0 vs. 1.6+/-0.9 at 6 months, p=0.77; p=0.036 vs. nitrate therapy).

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