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Effect of regression of left ventricular hypertrophy following sotalol therapy on diastolic function in hypertensive
M M Ibrahim1, S S Zaghloul, S M Helmi
1Cardiac Department, Cairo University, Egypt.
Insights
Sotalol therapy reduced left ventricular mass and improved diastolic filling in hypertensive patients. Improvements in diastolic filling were linked to reduced afterload, not solely decreased left ventricular mass.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is linked to increased left ventricular mass and impaired diastolic function.
- Beta-adrenergic blockade therapy is a common treatment for hypertension.
Purpose of the Study:
- To investigate the effects of sotalol on left ventricular mass and diastolic filling in patients with essential hypertension.
- To determine the relationship between changes in left ventricular mass and improvements in diastolic filling.
Main Methods:
- 16 patients with essential hypertension received sotalol (160 mg/day) or placebo for 8-12 weeks.
- Pulsed Doppler assessed left ventricular inflow time-velocity, measuring the peak atrial to peak early diastolic velocity (A:E) ratio and peak filling rate (PFR).
- Patients were divided into two groups based on the degree of left ventricular mass reduction (>15% vs. <15%).
Main Results:
- Sotalol significantly decreased mean arterial pressure (14%), heart rate (15%), and left ventricular mass (11%).
- Diastolic filling improved, with a 17% increase in the A:E ratio and a 21% increase in PFR.
- Patients with greater than 15% reduction in left ventricular mass showed less improvement in the A:E ratio compared to those with smaller reductions, despite similar changes in blood pressure and heart rate.
Conclusions:
- Sotalol effectively reduces left ventricular hypertrophy and enhances diastolic filling in hypertensive individuals.
- Improved diastolic filling appears to be primarily associated with afterload reduction rather than a decrease in left ventricular mass.
Abstract:
The effects of changes in left ventricular mass following beta-adrenergic blockade therapy (sotalol) on left ventricular filling indices were examined in 16 patients with essential hypertension aged 46 +/- 8.3 years (mean +/- s.d.). The peak atrial to peak early diastolic velocity (A:E) ratio and the peak filling rate (PFR = peak early diastolic velocity X mitral annulus area) were measured by the use of pulsed Doppler left ventricular inflow time-velocity plots following placebo and after 8-12 weeks of sotalol monotherapy (160 mg/day). Compared with normal controls of similar age, our patients had a larger left ventricular mass and impaired left ventricular filling indices. Following sotalol, mean arterial pressure (MAP) decreased by 14%, the heart rate by 15% and left ventricular mass by 11%, while diastolic filling improved (A:E 17% and PFR 21%). Six patients had a decrease in left ventricular mass of greater than 15% (group A); other patients (group B) showed a smaller reduction. In spite of comparable changes in MAP and heart rate in groups A and B, the patients in group A showed a smaller degree of improvement in the A:E ratio. It is concluded that sotalol can induce regression of left ventricular hypertrophy and improve left ventricular filling in hypertensive patients, and it seems that improvement in diastolic filling is related to a reduction in afterload rather than to a decrease in left ventricular mass.