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BACKGROUND: Left ventricular hypertrophy(LVH) is the independent poor prognostic factor in hypertensives. But, it is uncertain that the reduction of LVH by antihypertensives therapy will improve the prognosis of hypertensive patioents. THe effect of reduction of LVH on LV function(espacially diastolic function) and the mechanism of reduction of LVH are not clarified also. The aim of this study was to ascertain whether reduction in LV mass with enalapril has a beneficial effect ofn LV diastolic filling in hypertensive patients with diastolic dysfunction. METHODS: Mild to moderate hypertensive patients were treated with enalapril(10-20mg once daily) for 4 months. Their blood pressure and pulse rate were regularly measured devery 2 weeks. Using M mode echocardiograms, LV dimensions at end-diastole and end-systole, thicknesses of ventricular septum and LV free wall were measured. LV ejection fraction(EF), LV mass index(LVMI) and total peripheral resistance(TPR) were calculated. Pulsed ddoppler examination of transmitranl flow for assessment of LV diastolic function was performend from apical four chamber viw. The peak flow velocities of the early and late waves and their ratio(PFVE, PFVA, PFVE/PFVA) were measured from consecutive 3 cardiac cycles. In addition, the time velocity integral of the early and late waves and their ratio(EA, AA, EA/AA) were measured. Echocardiographic evaluations were performed at baseline and at the end of treatment. RESULTS: Average systolic and diastolic blood pressure decreased after treatment with enalapril. But there was no significant difference of pulse rate between basal and after treatment. The LV dimensions at end-diastole and end-systole and the thickness of LV free wall didn't change significantly. The thickness of interventricular septum, LVMI and TPR reduced significantly after treatment. The ejection fraction of LV didn't change significantly after treatment. There was no significant change in PFVE, EA, AA and EA/AA. But PFVA was significantly decreased after treatment with enalapril for 4 months. PFVE/PFVA was significantly increased also. CONCLUSION: In conclusion, antihypertensive treatment with enalapril led to a significant reduction of LVH partially associated with improvement in LV diastolic performance and no deterioration of LV systolic function.
Antihypertensive Agents ; Blood Pressure ; Echocardiography ; Enalapril ; Heart Rate ; Humans ; Hypertension* ; Prognosis ; Ventricular Septum

Gated myocardial SPECT and attenuation correction gave birth to new insights into the pathophysiology of ischemic myocardial perfusion and function in clinical routine practice. Gated myocardial Tc-99m-compound SPECT improved diagnostic accuracy of coronary artery disease and enabled us to observe motion and thickening of myocardial walls as well as myocardial perfusion at the same time. Quantitative and qualitative assessement of myocardial performance and perfusion let us to understand the myocardial physiology in ischemia and infarction. In every patient who underwent gated perfusion SPECT, we will find ejection fraction, left ventricular volumes and regional wall motion. There are hopes to use gated T1-201 SPECT for the same purpose and to use gated SPECT for evaluation of wall motion and thickening at stress or immediate post-stress. Attenuation correction could improve diagnostic accuracy mainly by increasing normalcy ratio or performance of non-expert physicians. Both gated methods and attenuation correction improved specificity of non-expert physicians in diagnosing patients with moderate pretest likelihood. New imaging techniques will fill the desire of cardiologists examine function and perfusion, and possibly metabolism in their clinical routine practice.
Coronary Artery Disease ; Hope ; Humans ; Infarction ; Ischemia ; Linear Energy Transfer ; Metabolism ; Parturition ; Perfusion* ; Physiology ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*