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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 4, July/August 2019
222
AFRICA
The effect of perindopril on echocardiographic
parameters, NYHA functional class and serum
NT-proBNP values in patients with diastolic heart failure
Umit Yuksek, Levent Cerit, Nihan Kahya Eren, Oktay Ergene
Abstract
Introduction:
Growing evidence has demonstrated that dias-
tolic heart failure occurs in about half of heart failure
(HF) patients. We investigated the effects of perindopril on
echocardiographic parameters, New York Heart Association
(NYHA) functional class and serum N-terminal pro B-type
natriuretic peptide (NT-proBNP) levels in patients with dias-
tolic heart failure.
Methods:
In total, 108 diastolic heart failure patients aged
≥
50
years, who had diastolic dysfunction with an ejection fraction
≥
50%, were enrolled and randomised to one of the two study
groups. Perindopril was initiated in the study group and the
control group was given standard therapy. Echocardiographic
parameters, NT-proBNP levels and NYHA classes were
recorded. The patients were followed for 11 (three to 16)
months. Eighty-eight patients completed the study.
Results:
Although diastolic parameters were not changed, A
′
(septal) velocity (10.8 vs 9.9 cm/s) and Sm (septal) velocity
(8.5 vs 7.6 cm/s) were significantly increased in the perindopril
compared to the control group. A significant increase in A
′
(septal) velocity (
+
0.61 vs –0.28 cm/s,
p
=
0.04) and a slight
increase in Sm (septal) velocity (
+
0.99 vs 0.36 cm/s,
p
=
0.054)
were noted in the perindopril group.
Conclusions:
Tissue Doppler septal late diastolic velocities
and septal systolic myocardial velocities increased in the
perindopril group but NT-proBNP levels, and NYHA class
was not changed in this study population.
Keywords:
diastolic heart failure, perindopril, NT-proBNP,
transthoracic echocardiography
Submitted 9/11/18, accepted 21/4/19
Published online 24/5/19
Cardiovasc J Afr
2019;
30
: 222–227
www.cvja.co.zaDOI: 10.5830/CVJA-2019-022
Heart failure (HF) with normal or preserved ejection fraction
(HFpEF), also called diastolic heart failure (DHF), occurs
in about half of HF patients. DHF is defined as a clinical
syndrome in patients with symptoms and/or signs of HF who
have an ejection fraction of
≥
50%, accompanied by elevated
natriuretic peptide levels and relevant structural heart disease
(left ventricular hypertrophy and/or left atrial enlargement) or
diastolic dysfunction on echocardiography according to 2016
European Society of Cardiology guidelines for heart failure.
1
Diastolic dysfunction (DD) is an important component of
HFpEF.
In some previous studies, DD was an inclusion criterion for
the study (e.g. PEP-CHF study), whereas it was not a prerequisite
in others (e.g. I-PRESERVE or CHARM-Preserved trials). In an
echocardiographic sub-study of the CHARM-Preserved trial,
67% of the patients had DD.
2
Left atrial (LA) function, which
is a component of diastolic function, is also an important
contributor to the pathophysiology of HFpEF. Several previous
studies demonstrated that increased LA size and decreased LA
systolic function are the most important part of the HFpEF.
3,4
Parameters indicating LA systolic function may be found
abnormal in HFpEF patients during exercise and may correlate
with reduced exercise capacity in these patients.
5
There are many
ways to assess LA systolic function, such as measurements of
LA systolic strain, LA emptying fraction and end-diastolic
mitral annular velocity in pulsed tissue Doppler. Doppler tissue
imaging of the mitral annulus during atrial systole has been
shown to be a practical method to quantify left atrial contractile
function.
6
This parameter (Am) correlates well with the changes
in LA fractional area, and it therefore provides an easy way to
assess LA systolic function.
It has long been evident that this disease is not only a disease
of diastolic function. A number of studies have shown that
left ventricular longitudinal function, which is a component of
systolic function that can be measured as myocardial systolic
velocity (Sm) in tissue Doppler echocardiography (TDE), is also
reduced in these patients, even though the ejection fraction is
within the so-called ‘normal’ or ‘preserved’ limits.
7-13
Benefits of some drugs were demonstrated on diastolic
function in DHF patients. A calcium channel blocker (CCB),
verapamil, was shown to have some benefit on diastolic function
in patients with HFpEF.
14,15
Recently eplerenone induced
improvements in diastolic echocardiographic measures (e.g.
E/E
′
parameter) in HFpEF patients.
16
In the Hong Kong
diastolic heart failure study, both irbesartan and ramipril,
added to diuretics in HFpEF patients, increased mean peak
systolic (Sm) and early diastolic (Em) mitral annular velocities
in TDE.
17
There are also some studies investigating the effects of
perindopril on diastolic function in patients with hypertension
(HT), diabetes mellitus (DM), or stable coronary artery disease
Department of Cardiology, Near East University Hospital,
Nicosia, Cyprus
Umit Yuksek, MD
Levent Cerit, MD,
drcerit@hotmail.comDepartment of Cardiology, Izmir Ataturk Education and
Research Hospital, Izmir, Turkey
Nihan Kahya Eren, MD
Department of Cardiology, 9 Eylul University Hospital,
Izmir, Turkey
Oktay Ergene, MD