Abstract

Introduction

Materials & Methods

Results

Discussion & Conclusion

References

Discussion
Board

BACKGROUND: Restrictive left ventricular (LV) filling is associated with more severe chronic heart failure (CHF) and is predictive of cardiac death. This study was designed to determine whether additional vasodilator (nitrate) therapy affects the restrictive filling pattern in patients with CHF. Effects on clinical status, exercise capacity and LV systolic function were also studied. METHODS: We studied 47 patients with CHF caused by ischemic heart disease or idiopathic dilated cardiomyopathy (NYHA class II-IV). 23 patients were randomized to standard treatment (digitalis, diuretics and angiotensin-converting enzyme inhibitors) and 24 to a nitrate (isosorbide-5-mononitrate 20 mg b.i.d.) in addition to standard therapy. Doppler echocardiography was performed at baseline and after 6 months of therapy. RESULTS: At baseline all patients (100%) had a restrictive LV filling pattern (peak early [E] to atrial [A] filling velocity ratio > 2 or E/A between 1 and 2 and E wave deceleration time < 140 ms). Restrictive LV filling persisted in 70% (n=16) of patients on standard therapy versus 33% (n=8) on additional nitrate therapy (p<0.05). Vasodilator therapy was also associated with a more significant improvement in NYHA class, 6-minute walk distance, left atrial size and mitral regurgitation grade, but not in LV volumes and ejection fraction. CONCLUSIONS: In patients with CHF on standard pharmacological treatment, additional nitrate therapy is effective in reverting a restrictive pattern of LV diastolic filling into a nonrestrictive pattern. This effect is accompanied by an improvement in clinical status and exercise capacity but not in LV systolic function.

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Poster Number PAnikitin0543
Keywords: heart failure, diastole, nitrates