Cardiovascular Diseases Poster Session



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Effects Of Additional Vasodilator Therapy In Patients With Chronic Heart Failure And Restrictive Left Ventricular Filling

Contact Person: Nikolay P Nikitin (nimed@silk.org)


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.

ParameterStandard therapy(n=23) Nitrate(n=24)
Age (years) 51+/-14 56+/-10
NYHA class 2.7+/-0.47 2.79+/-0.41
Six-minute walk test distance (m) 206+/-114 205+/-70
Heart rate (beats/min) 86+/-14 87+/-12
Systolic Arterial Pressure (mm Hg) 123+/-20 126+/-17
Diastolic Arterial Pressure (mm Hg) 78+/-13 81+/-12
Left atrial size (mm) 49+/-5 51+/-6
End-Diastolic Volume (ml) 291+/-53 296+/-54
End-Systolic Volume (ml) 211+/-46 218+/-49
Ejection Fraction (%) 28+/-6 27+/-6
Peak Velocity of Early Filling (m/s) 0.61+/-0.1 0.62+/-0.12
Peak Velocity of Atrial Filling (m/s) 0.31+/-0.05 0.29+/-0.07
PE/PA ratio 2.01+/-0.24 2.18+/-0.42
Deceleration Time of Early Filling (ms) 120+/-11 123+/-10
Mitral Regurgitation 83% 58%
Restrictive pattern 100% 100%

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

ParameterBaseline Six months p value Over time Vs. p value of standard
therapy 6 months
LVEDV (ml)
291+/-53 280+/-55 0.042 -----
Nitrate 296+/-54 286+/-45 0.016 0.674
LVESV (ml)
211+/-46 198+/-48 0.028 -----
Nitrate 218+/-49 208+/-42 0.001 0.445
LVEF (ml)
28+/-6 30+/-6 0.085 -----
Nitrate 27+/-6 28+/-6 0.180 0.250
PE (m/s)
0.61+/-0.1 0.59+/-0.07 0.364 -----
Nitrate 0.62+/-0.12 0.58+/-0.10 0.005 0.582
PA (m/s)
0.31+/-0.05 0.33+/-0.08 0.110 -----
Nitrate 0.29+/-0.07 0.37+/-0.06 0.000 0.048
PE/PA ratio
2.01+/-0.24 1.93+/-0.66 0.616 -----
Nitrate 2.18+/-0.42 1.59+/-0.43 0.000 0.041
DT (ms)
120+/-11 134+/-16 0.002 -----
Nitrate 123+/-10 143+/-14 0.000 0.040

100% 70% 0.000 -----
Nitrate 100% 33% 0.013 0.028

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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Nikitin, NP.; Alyavi, AL.; Goloskokova, VY.; (1998). Effects Of Additional Vasodilator Therapy In Patients With Chronic Heart Failure And Restrictive Left Ventricular Filling. Presented at INABIS '98 - 5th Internet World Congress on Biomedical Sciences at McMaster University, Canada, Dec 7-16th. Available at URL http://www.mcmaster.ca/inabis98/cvdisease/nikitin0543/index.html
© 1998 Author(s) Hold Copyright