Effects of quinapril on left atrial structural remodeling and arterial stiffness.
Left atrial (LA) enlargement, left ventricular (LV) diastolic dysfunction, and increased arterial stiffness are all associated with adverse cardiovascular outcomes. The rate, magnitude, and concordance of modifiability of these risk markers have not been well characterized. Twenty-one patients (mean age 69 +/- 8 years; 52% women) with isolated diastolic dysfunction and indexed LA volumes > or =32 ml/m(2) were randomly assigned to receive either quinapril at a target dose of 60 mg/day or matching placebo for 12 months. Echocardiographic maximum LA volume and LV diastolic function and arterial stiffness by the augmentation index were measured at baseline and 6 and 12 months. Analysis was based on intention to treat. Baseline characteristics were comparable between the treatment (n = 9) and placebo (n = 12) groups. The mean reduction in LA volume of 4.2 +/- 7.8 ml/m(2) in the quinapril group was significant (p = 0.01) compared with the increase in LA volume in the placebo group (5.5 +/- 8.1 ml/m(2)). This represents a relative improvement of 9.7 ml/m(2). Change in LV filling pressure in terms of E/e' and diastolic function grade did not reach significance. A reduction in the augmentation index was associated with a decrease in indexed LA volume (odds ratio 11, p = 0.046), independent of changes in systolic blood pressure. In conclusion, LA structural remodeling appeared reversible with quinapril, which occurred in parallel with an improvement in arterial stiffness but independent of blood pressure changes.
Tsang
Teresa S M
TS
Division of Cardiovascular Diseases and Internal Medicine, Rochester, Minnesota, USA. tsang.teresa@mayo.edu
Barnes
Marion E
ME
Abhayaratna
Walter P
WP
Cha
Steven S
SS
Gersh
Bernard J
BJ
Langins
Andrew P
AP
Green
Tammy D
TD
Bailey
Kent R
KR
Miyasaka
Yoko
Y
Seward
James B
JB
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D016279:Atrial Function, Left / Q000187:drug effects* / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects; D002306:Cardiac Volume / Q000187:drug effects* / Q000502:physiology; D003971:Diastole / Q000187:drug effects; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000187:drug effects*; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077583:Quinapril; D044005:Tetrahydroisoquinolines / Q000494:pharmacology*; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D044005:Tetrahydroisoquinolines; D000077583:Quinapril