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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 4, July/August 2019
224
AFRICA
Results
The mean age of the patients was 62 years (50–83). Of all
patients, 78% were women; 81.8% were hypertensive, and 31%
had a history of heart failure. Sixty-one per cent of the patients
were receiving CCBs, 39% were receiving beta-blockers, and
55.6% were using diuretics. One per cent of the patients were in
NYHA functional class 1, 68% were in NYHA class 2, and 31%
were in NYHA class 3.
During the 11 months of follow up, seven patients withdrew
from the study and three patients died. Perindopril treatment
was discontinued in 10 patients due to side effects (dry cough
and hypotension). Therefore, at the end of the study period,
the perindopril group consisted of 37 patients and the control
group included 51 patients. The final analyses of the study
were made on the data from 88 patients. The patients in the
perindopril group used CCBs more frequently than the patients
in the control group (76 vs 51%,
p
=
0.026). The other clinical
and demographic characteristics were similar between the two
groups (Table 1).
Echocardiographic parameters: At the study baseline, the
mean visual EF of the patients was 64%, and the mean EF on
M-mode was 65%. Mean left atrial volume index (LAVI) was
24 ml/m
2
. The mean E/A ratio was 0.80, while the average E
′
(mean) velocity was 6.5 cm/s. The average A
′
(septal) velocity
was measured as 10.1 cm/s, whereas A
′
(lateral) velocity was
10.2 cm/s and A
′
(mean) velocity was 10.2 cm/s. The E/E
′
(mean)
ratio was 11.2. The average Sm (septal) velocity was 7.2 cm/s,
and Sm (lateral) velocity was 7.0 cm/s; Sm (mean) velocity was
7.2 cm/s. Twenty-six per cent of the patients had left ventricular
hypertrophy (LVH); 85% had grade 1 DD, and 15% had grade
2 DD. None of the patients had grade 3 DD. There was no
significant difference between the two groups in terms of the
baseline echocardiographic parameters (Table 2).
Primary outcomes: At the end of the follow-up period, EF
values were similar between the two groups. Mean LAVI values,
mean E/A ratios, average E
′
(mean) velocities, average A
′
(mean)
velocities, E/E
′
(mean) ratios were also not significantly different
between the two groups. LVH was found in 30 and 26% of the
patients in the perindopril and control groups, respectively.
When we compared the echocardiographic parameters of the
two groups at the end of the follow-up period, all parameters
were comparable except for significant differences noted in A
′
(sep), Sm (sep) and Sm (mean) velocities. A
′
(sep), Sm (sep) and
Sm (mean) velocities were significantly higher in the perindopril
group (Table 3). A
′
(sep) velocity in the perindopril group
was significantly higher than in the control group (10.8 vs 9.9
cm/s, 95% CI: 0.065–1.795,
p
=
0.036). Sm (sep) velocity was
also elevated in the perindopril group (8.5 vs 7.6 cm/s, 95% CI:
0.127–1.791,
p
=
0.025). Sm (mean) velocity was also higher in
the perindopril group (8.3 vs 7.7 cm/s, 95% CI: 0.046–1.163,
p
=
0.034). DT and IVRT values were similar between the two
Table 1. Comparison of the baseline characteristics of the study groups
Variable
Perindopril group
(
n
= 37)
Control group
(
n
= 51)
p
-value
Age (years)
62
±
8
61
±
8
0.879
Female,
n
(%)
31 (84)
38 (75)
0.432
Hypertension,
n
(%)
31 (84)
41 (80)
0.784
Diabetes mellitus,
n
(%)
19 (51)
17 (33)
0.124
Coronary artery disease,
n
(%)
4 (11)
11 (22)
0.254
Peripheral arterial disease,
n
(%)
2 (5)
0 (0)
0.174
Hyperlipidaemia,
n
(%)
18 (49)
30 (59)
0.390
Antihyperlipidaemics,
n
(%)
5 (14)
10 (20)
0.571
Aspirin,
n
(%)
15 (41)
20 (39)
1.000
Calcium antagonists,
n
(%)
28 (76)
26 (51)
0.026
Beta-blockers,
n
(%)
15 (41)
20 (39)
1.000
Antidiabetics,
n
(%)
15 (41)
12 (24)
0.105
Diuretics,
n
(%)
19 (51)
30 (59)
0.521
Body mass index (kg/m²)
33
±
6
33
±
5
0.914
Systolic blood pressure (mmHg)
126
±
16
123
±
19
0.341
Diastolic blood pressure (mmHg)
76
±
12
73
±
13
0.388
Serum creatinine level (mg/dl)
0.92
±
0.14
0.98
±
0.25 0.126
NYHA class,
n
(%)
2
29 (78)
33 (65)
0.237
3
8 (22)
18 (35)
NT-proBNP (pg/ml)
Median
114
128
0.391
NYHA; New York Heart Association.
Table 2. Comparison of the baseline echocardiographic
parameters in the study groups
Variable
Perindopril group
(
n
= 37)
Control group
(
n
= 51)
p
-value
LA diameter (mm)
39
±
5
40
±
4
0.742
LVH,
n
(%)
11 (30)
12 (24)
0.624
LAV (ml)
44
±
11
46
±
11
0.382
LAVI (ml/m²)
24
±
6
25
±
6
0.726
EF (%)
66
±
7
65
±
8
0.591
E velocity (m/s)
0.75
±
0.17
0.72
±
0.17 0.446
A velocity (m/s)
0.94
±
0.20
0.95
±
0.24 0.902
E/A ratio
0.83
±
0.26
0.80
±
0.24)
0.537
E
′
(sep) velocity (cm/s)
6.5
±
1.0
6.5
±
0.8
0.925
E
′
(lat) velocity (cm/s)
6.7
±
0.9
6.5
±
1.0
0.327
A
′
(sep) velocity (cm/s)
10.2
±
1.7
10.2
±
1.6
0.919
A
′
(lat) velocity (cm/s)
10.3
±
2.6
10.2
±
2.1
0.867
E
′
(mean) velocity (cm/s)
6.6
±
0.8
6.5
±
0.8
0.491
A
′
(mean) velocity (cm/s)
10.3
±
1.8
10.2
±
1.5
0.872
E
′
/A
′
(sep) ratio
0.65
±
0.13
0.66
±
0.11 0.880
E
′
/A
′
(lat) ratio
0.67
±
0.15
0.66
±
0.16 0.569
E
′
/A
′
(mean) ratio
0.66
±
0.12
0.65
±
0.12 0.684
E/E
′
(sep) ratio
11.7
±
2.8
11.2
±
2.8
0.472
E/E
′
(lat) ratio
11.3
±
2.7
11.4
±
3.1
0.953
E/E
′
(mean) ratio
11.4
±
2.5
11.2
±
2.8
0.787
Sm (lat) velocity (cm/s)
7.3
±
1.9
7.0
±
1.5
0.450
Sm (sep) velocity (cm/s)
7.5
±
2.0
7.2
±
1.3
0.351
Sm (mean) velocity (cm/s)
7.4
±
1.7
7.1
±
1.1
0.350
DD grade,
n
(%)
Grade 1
31 (84)
42 (82)
1.000
Grade 2
6 (16)
9 (18)
IVRT, mean (msn)
132
±
27
129
±
21
0.533
DT, mean (msn)
238
±
39
241
±
35
0.658
LA: left atrium, LVH: left ventricular hypertrophy, LAV: left atrial volume,
LAVI: left atrial volume index, EF: ejection fraction, E velocity: early diastolic
mitral inflow velocity, A velocity: late diastolic mitral inflow velocity, E/A: ratio
between early and late diastolic mitral inflow velocities, E
′
(sep) velocity: septal
tissue Doppler early diastolic mitral annular velocity, A
′
(sep) velocity: septal
tissue Doppler late diastolic mitral annular velocity, E
′
(lat) velocity: lateral
tissue Doppler early diastolic mitral annular velocity, A
′
(lat) velocity: lateral
tissue Doppler late diastolic mitral annular velocity, E
′
(mean) velocity: mean
tissue Doppler early diastolic mitral annular velocity, A
′
(mean) velocity: mean
tissue Doppler late diastolic mitral annular velocity, E
′
/A
′
(sep, lat, mean): the
ratio between septal/lateral/mean tissue Doppler early and late diastolic mitral
annular velocities, E/E
′
(sep, lat, mean): the ratio between septal/lateral/mean
early diastolic mitral inflow velocities and tissue Doppler early diastolic mitral
annular velocities, Sm (sep, lat, mean): septal/lateral/mean tissue Doppler
systolic mitral annular velocities, DD: diastolic dysfunction, IVRT: isovolumic
relaxation time, DT: deceleration time, SD: standard deviation.