Contents

Influence of Enalapril and Carvedilol on Left Ventricular Diastolic Filling Patterns in Patients with Heart Failure

Emukhvari N., Napetvaridze R., Emkhvari T.
Tbilisi State Medical University Clinic N1

The purpose of this study was to evaluate the effect of enalapril in combination with furosemide and carvedilol in combination with standard treatment (enalapril and furosemide) on left ventricular (LV) diastolic function in patients (pts) with heart failure (HF).

Method: Before and after 6 months of the treatment early and atrial peak velocities (E and A; cm/sec), E/A ratio, E-wave deceleration time (Dt; msec) and atrial filling fraction (AF; %) were studied in 107 pts (mean age 60.4±8.4 yrs) with HF (NYHA II-III, LVEF<40%). 75 pts had previous myocardial infarction and 32 idiophatic dilated cardiomyopathy. 53 pts were treated with enalapril and furosemide (Group I) and 54 pts with enalapril, furosemide and carvedilol (Group II).

Results: There were not significant differences in LV diastolic dysfunction rates for the two groups (67.9% and 72.2%, respectively). After treatment this rate significantly reduced in both groups (30.2% and 24.1%). In pts from both groups with LV relaxation abnormalities (LVRA) treatment with enalapril and furosemide induced significant increases in E, E/A and reduction in A and AF and in pts with restrictive type of diastolic dysfunction (RDD) significant increases in A, Dt and AF with a significant reduction in E/A. There was observed additional benefit effect of carvedilol on LV diastolic function - in pts with LVRA from Group II after treatment was observed significant reduction in Dt and in pts with RDD significant increases in E.

Conclusions: In patients with HF and I and II types of left ventricular diastolic dysfunction long-term treatment with enalapril induces significant improvement of left ventricular diastolic filling parameters; In pts with HF carvedilol in combination with enalapril more favorably influences on parameters of LV diastolic function, than enalapril, that is related to the additional benefit effect of carvedilol on LV diastolic function.

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