Кардиоваскулярная терапия и профилактика (Dec 2005)
Acute nitroglycerin test for predicting perindopril therapy effectiveness in patients with coronary heart disease and chronic heart failure
Abstract
Aim. To assess the role of acute nitroglycerin test (ANT) for predicting perindopril therapy effectiveness in patients with coronary heart disease (CHD) and chronic heart failure (CHF). Material and methods. In 127 CHD and CHF patients, assessment of left and right ventricular (LV, RV) contractility was performed, by balanced biventricular radioventriculography and segmental histogram analysis, according to standard protocol. The assessment was performed at baseline ANT and after 6 months of perindopril therapy. By ejection fraction (EF) figures, all participants were divided into two groups: Group I consisted of 89 patients with CHD an Functional Class (FC) II-III CHF, LVEF>40%; Group II included 38 CHD patients with FC III-IV CHF, LVEF<40%. Results. In ANT, Group I demonstrated significant increase in total LVEF, from 62.5±8.4% to 68.0±8.2%, some increase in RVEF, and significant decrease in end-diastolic and systolic volumes (EDV, ESV) - by 21.4 and 40.1%, respectively (р<0.05). In Group II, ANT was associated with increase in total LVEF, from 22.6±10.8% to 30.7±15.3% (р<0.02); RVEF increased from 30.4±13.3% to 37.2±13.8% (р<0.05); EDV and ESV did not change significantly. In both groups, zones of local dyskinesia Р hypo- and akynesia Р were identified. During ANT, the number of normokynetic zones increased, the number of hypokinetic zones decreased, especially in LV anteroseptal area. In patients with EF<40%, the number of LV lateral wall akynetic zones reduced significantly. After 6-month perindorpil treatment, local EF increased in LV lateral wall segments (Group I) and lateral wall (Group II), that correlated with substantial total EF increase. Conclusion. Improvement of local contractility in ANT was due to LV and RV zones with reversible dysfunction. Improved total and local contractility in ACT gives a chance to assess perindopril effectiveness in patients with CHD and FC II-IV CHF.
