The effects of ACE inhibitor therapy on left ventricular myocardial mass and diastolic filling in previously untreated hypertensive patients: A Cine MRI study

Abstract

Cardiac remodeling in case of hypertension induces hypertrophy of myocytes and elevated collagen content and, subsequently, impaired diastolic filling of the left ventricle. The purpose of this prospective study was to evaluate changes of left ventricular (LV) myocardial mass, as well as diastolic filling properties, in hypertensive patients treated with the ACE inhibitor fosinopril. Sixteen hypertensive patients with echocardiographically documented LV hypertrophy and diastolic dysfunction received fosinopril (10 -20 mg daily). Measurements of LV myocardial mass and properties of diastolic filling (peak filling fraction (PFF); peak filling rate (PFR)) were performed prior to medication, as well as after 3 and 6 months of therapy using cine magnetic resonance imaging (MRI). LEFT VENTRICULAR (LV) HYPERTROPHY has been identified as an independent risk factor for cardiovascular mortality, accompanied by an increased incidence of ischemic events and sudden death or heart failure (1,2). The presence of LV hypertrophy in hypertensive patients can be initially regarded as an adaptive process that compensates for chronic pressure overload and preserves sufficient systolic wall stress and pump function (3). However, the remodeling process leads to functional changes like adaptive molecular modifications in myocardial myocytes, as well as morphologic alterations, including hypertrophy of myocytes and an elevated ventricular collagen content (myocardial fibrosis). These alterations are mainly triggered by angiotensin II (AT II) and are responsible for impairment of diastolic filling and increased myocardial stiffness of the LV (4,5).ACE inhibitors have been shown to effectively control blood pressure (BP) and reduce LV myocardial mass in numerous clinical and echocardiographic studies (6 -10). It is well-known that ACE inhibitors exert additional local actions, which are not related to only hemodynamic changes. Animal studies have proposed a selective enhancement of LV relaxation by ACE inhibitors via an endogenous bradykinin/nitric oxide pathway (11). In addition, ramipril has been demonstrated to have a direct effect on the mRNA expression for myocardial collagen I and II, unrelated to the effect of BP control (12).Although ACE inhibitors exert direct effects on the pathomechanism on cardiac alterations in the course of pressure overload, there is little information regarding the time course of BP lowering, reduction of LV mass, and subsequent normalization of diastolic filling. In the present study, we used serial clinical and cine MRI examinations to accurately analyze regression of LV hypertrophy, as well as its effects on parameters of LV diastolic filling during treatment with the ACE inhibitor fosinopril. METHODS PatientsSixteen previously untreated patients with essential hypertension (systolic BP ϭ 158 Ϯ 11 mm of Hg, dia-

The BNP assay does not identify mild left ventricular diastolic dysfunction in asymptomatic diabetic patients

“…Around 30% of patients with DHF have diabetes. 22 Although it is still not clear whether any drug intervention changes the prognosis of DHF patients, other than hypertension control, 24 diastolic function may be improved by aerobic exercise 25 and angiotensin converting enzyme inhibitors 26 and tight glycemic control decreases the risk of HF in individuals with diabetes. 27 Hence there is a need, in diabetic patients, for identifying those with initial diastolic impairment.…”

Correlation Between Late Gadolinium Enhancement and Diastolic Function in Hypertrophic Cardiomyopathy Assessed by Magnetic Resonance Imaging

“…26 In the current study, the true temporal resolution of the cine MR images acquired with a steady-state MR sequence was 32 ms, which was substantially better than that used in previous studies. [5][6][7][8][10][11][12][13] …”

“…Although this approach enables detection of altered LV filling during early diastole, little information can be obtained for assessing any abnormality during the isovolumic period before wall motion begins. 10 Invasive catheterization is still required for measuring altered isovolumic LV relaxation, LV diastolic distensibility and LV chamber stiffness in HCM patients and accurate assessment of regional diastolic function is difficult with the current MR approach, even using tagged MRI.…”

“…9 With recent improvements in fast cardiac magnetic resonance imaging (MRI), cine MRI can now provide an accurate measurement of diastolic function, as well as LV wall thickness, volume and ejection fraction (EF). 10,11 It has been shown that myocardial fibrosis is common in patients with HCM, even in the absence of significant epicardial coronary artery disease. [12][13][14] Late gadoliniumenhanced MRI can identify regions of myocardial scarring that cannot be well detected by other noninvasive imaging modalities.…”

Magnetic resonance assessment of left ventricular diastolic dysfunction for detecting cardiac allograft vasculopathy in recipients of heart transplants

“…In addition, this study was performed in recipients late after transplantation (8.5 ± 4.4 years); thus, further studies at earlier time points after transplantation also would be desirable. A second limitation is that although cine MR allows assessment of the LV time-volume curve and calculation of the PFR from its first derivative curve, thus enabling detection of altered LV filling during early diastole, the technique provides little information for evaluating any abnormality during the isovolumetric period before wall motion begins [40]. Strict measurement of altered isovolumetric LV relaxation, LV diastolic distensibility, and LV chamber stiffness still requires invasive catheterization, and accurate assessment of regional diastolic function is difficult with this approach.…”