Russian Heart Failure Journal 2005year Effect of ACE inhibitors and angiotensin II antagonists on left ventricular diastolic function in patients with heart failure and relatively safe left ventricular systolic function: Results of the study Perindopril IRbesartan and AmlodipiNe in patients witH CHF and safe left ventricular systolic function (PIRANHA)


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2005/

Effect of ACE inhibitors and angiotensin II antagonists on left ventricular diastolic function in patients with heart failure and relatively safe left ventricular systolic function: Results of the study Perindopril IRbesartan and AmlodipiNe in patients witH CHF and safe left ventricular systolic function (PIRANHA)

Mareev V.Yu., Ovchinnikov A.G., Ageev F.T., Belenkov Yu.N.

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Urgency. Pathogenetic treatment of left ventricular (LV) diastolic dysfunction (DD) should first of all provide an effect on myocardial rigid properties. In this respect great prospects are related to the drugs inhibiting the activity of renin-angiotensin-aldosterone system (RAAS), i.e., ACE inhibitors (ACEI), and angiotensin II antagonists (AAII). Aim. To compare effects of ACEI and AAII on LV diastolic function (DF) in patients with chronic heart failure (CHF) and relatively safe LV systolic function. Materials. Fifty-four patients with I–III NYHA functional class (FC) CHF and LV ejection fraction (EF) >40% were randomized to the AAII irbesartan treatment group (n=27; 300 mg/day) or the ACEI perindopril treatment group (n=27; 8 mg/day). The LV DF was measured at baseline and after 12 and 24 weeks of study by the transmitral flow (TF) at rest and at peaks of loading tests, isometric handgrip (HG) and cold test (CT), during which the diastolic reserve (DR) was calculated from the VE/VA decrease at a peak load. Results. In patients with mild LV DD, both treatments resulted in unidirectional changes in TF parameters at rest (isovolumetric relacsation time [IVRT] and DT shortening and VE/VA increase) and improvement of DR. However in patients with advanced LV DD, the LV DF changes were directly opposite in many respects. For instance, the irbesartan treatment was associated with the decreased VE/VA ratio, prolonged IVRT and DT, and improved DR while the perindopril treatment was associated with the increased VE/VA ratio, shortened IVRT and DT, and even more exhausted DR. Conclusions. Both irbesartan and perindopril improve the LV DF at rest and peak testing loads in patients with CHF, virtually safe LV systolic function, and mild DD. At the same time in patients with advanced LV DD, irbesartan more efficiently influences the pattern of LV filling at rest and the state of DR as compared to perindopril.

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