title: Angiotensin-converting enzyme (ACE) inhibitors revert abnormal right ventricular filling in patients with restrictive left ventricular disease.
abstract: OBJECTIVE
  Our aim was to determine mechanisms underlying abnormalities of right ventricular (RV) diastolic function seen in heart failure.
  
  
  BACKGROUND
  It is not clear whether these right-sided abnormalities are due to primary RV disease or are secondary to restrictive physiology on the left side of the heart. The latter regresses with angiotensin-converting enzyme inhibition (ACE-I).
  
  
  METHODS
  Transthoracic echo-Doppler measurements of left- and right-ventricular function in 17 patients with systolic left ventricular (LV) disease and restrictive filling before and 3 weeks after the institution of ACE-I were compared with those in 21 controls.
  
  
  RESULTS
  Before ACE-I, LV filling was restrictive, with isovolumic relaxation time short and transmitral E wave acceleration and deceleration rates increased (p < 0.001). Right ventricular long axis amplitude and rates of change were all reduced (p < 0.001), the onset of transtricuspid Doppler was delayed by 160 ms after the pulmonary second sound versus 40 ms in normals (p < 0.001) and overall RV filling time reduced to 59% of total diastole. Right ventricular relaxation was very incoordinate and peak E wave velocity was reduced. Peak RV to right atrial (RA) pressure drop, estimated from tricuspid regurgitation, was 45+/-6 mm Hg, and peak pulmonary stroke distance was 40% lower than normal (p < 0.001). With ACE-I, LV isovolumic relaxation time lengthened, E wave acceleration and deceleration rates decreased and RV to RA pressure drop fell to 30+/-5 mm Hg (p < 0.001) versus pre-ACE-I. Right ventricular long axis dynamics did not change, but tricuspid flow started 85 ms earlier to occupy 85% of total diastole; E wave amplitude increased but acceleration and deceleration rates were unaltered. Values of long axis systolic and diastolic measurements did not change. Peak pulmonary artery velocity increased (p < 0.01).
  
  
  CONCLUSIONS
  Abnormalities of RV filling in patients with heart failure normalize with ACE-I as restrictive filling regresses on the left. This was not due to altered right ventricular relaxation or to a fall in pulmonary artery pressure or tricuspid pressure gradient, but appears to reflect direct ventricular interaction during early diastole.
authors.affiliation: Royal Brompton Hospital, London, England, United Kingdom.
authors.forename: M Y
authors.initials: MY
authors.lastname: Henein
authors.forename: C A
authors.initials: CA
authors.lastname: O'Sullivan
authors.forename: A J
authors.initials: AJ
authors.lastname: Coats
authors.forename: D G
authors.initials: DG
authors.lastname: Gibson
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D003971:Diastole / Q000187:drug effects; D018619:Echocardiography, Doppler, Pulsed; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D014694:Ventricular Outflow Obstruction / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors