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Changes in ventricular volume, wall thickness and wall stress during progression of left ventricular dysfunction. The
H G Pouleur1, M A Konstam, J E Udelson
1Department of Physiology and Pharmacology, University of Louvain, Medical School, Brussels, Belgium.
Insights
Enalapril slowed left ventricular dilation in asymptomatic patients with severe heart dysfunction over 1 year. However, cardiac wall stress did not normalize, suggesting ongoing remodeling stimuli.
Area of Science:
- Cardiology
- Heart Failure Research
Background:
- Asymptomatic patients with severe left ventricular dysfunction require long-term monitoring for cardiac changes.
- Understanding ventricular remodeling progression is crucial for effective therapeutic strategies.
Purpose of the Study:
- To evaluate long-term cardiac function changes in asymptomatic patients with severe left ventricular dysfunction.
- To assess the impact of enalapril on ventricular remodeling and cardiac function.
Main Methods:
- Baseline assessment of left and right ventricular function using cineangiography and radionuclide angiography in 49 patients.
- Follow-up assessment after 12.4 months in 30 patients (placebo vs. enalapril groups).
- Analysis of changes in ventricular volumes, pressures, ejection fraction, and wall stress.
Main Results:
- Enalapril group showed modest but significant reductions in left ventricular end-diastolic and end-systolic volumes compared to placebo.
- Ejection fraction showed non-significant improvements in both placebo (29% to 31%) and enalapril (28% to 32%) groups.
- Mean systolic wall stress increased insignificantly in both groups, indicating incomplete normalization with enalapril at studied doses.
Conclusions:
- Severe left ventricular dysfunction progresses slowly with ventricular dilation even in asymptomatic patients.
- Enalapril demonstrated a potential to slow the progression of left ventricular dilation.
- Treatment with enalapril did not normalize cardiac wall stress, implying persistent stimuli for adverse cardiac remodeling.
Abstract:
To assess the long-term changes in cardiac function in asymptomatic patients with severe left ventricular dysfunction, left ventricular (cineangiography) and right ventricular (radionuclide angiography) function were assessed at baseline in 49 patients enrolled in the prevention arm of the Studies of Left Ventricular Dysfunction. After an average follow-up period of 12.4 months, 30 patients (11 randomized to the placebo group and 19 to the enalapril group) could be restudied to assess the progression of ventricular dysfunction. After 1 year of follow-up, the changes in heart rate, left ventricular end-diastolic and systolic pressure and right ventricular volumes were comparable in both groups. However, there were modest but opposite changes in left ventricular end-diastolic volume (+9 ml/m2 with placebo vs. -10 ml/m2 with enalapril, p < 0.05) and end-systolic volume (+5 ml/m2 with placebo vs. -13 ml/m2 with enalapril, p < 0.05). Mean systolic wall stress increased insignificantly in both groups, whereas ejection fraction increased from 29% to 31% in the placebo group and from 28% to 32% with enalapril (p = NS, placebo vs. enalapril). Even in asymptomatic patients with severe left ventricular dysfunction, there was a slow progression of left ventricular dilation. Enalapril administration appeared to slow this progression, but wall stress was not normalized by the treatment at the doses used in the study, indicating that at least one of the stimuli for further remodeling remained present.