Improvement of left ventricular diastolic dysfunction in hypertensive patients 1 month after ACE inhibition therapy: evaluation by ultrasonic automated boundary detection.

Abstract

The purpose of this study was to detect any improvement in left ventricular diastolic dysfunction in hypertensive patients 1 month after cilazapril therapy. Twenty-three patients, 5 men and 18 women (mean age, 53.52 +/- 9.10 years), with mild or moderate hypertension (160 +/- 13/98 +/- 10 mm Hg), and free of other cardiac or systemic diseases, were studied using ultrasonic automated boundary detection (ABD) and pulsed Doppler echocardiography, before and 1 month after a daily dose of 2.5 mg of cilazapril. The following new ABD diastolic indices were determined: the time rate of area change in early diastole (dA/dt)E, that in late diastole (dA/dt)A, and their ratio (dA/dt)E/(dA/dt)A, while Doppler transmitral flow measurements of left ventricular diastolic filling were also simultaneously recorded. The ABD results showed left ventricular diastolic dysfunction (LVDD) in 9 of 23 patients (39%) compared with the ABD values of 12 normal volunteers. Neither method revealed any significant difference before and after treatment in the patient group as a whole. However, in the group of 9 patients with diastolic dysfunction, the ABD ratio (dA/dt)E/(dA/dt)A was significantly improved after cilazapril therapy (1.20 +/- 0.21 versus 1.41 +/- 0.17; P < 0.05). We concluded that a large percentage (39%) of patients with mild or moderate hypertension had reduced diastolic performance of the left ventricle at a stage of the disease when systolic dysfunction and/or hypertrophy were not evident. Significant improvement of diastolic dysfunction in hypertensive patients could be detected by the proposed ABD new diastolic indices 1 month after cilazapril therapy. In conclusion, automatic boundary detection should be a useful non-invasive modality for the early diagnosis of left ventricular diastolic dysfunction, as well as early recognition of its improvement.