Abstract 14544: Ramipril Efficacy on Left Ventricular Systolic and Diastolic Function in Stable Patients With Pulmonary Regurgitation After Repair of Tetralogy of Fallot
Introduction: We reported previously complex results of the APPROPRIATE (ACE inhibitors for Potential PRevention Of the deleterious effects of Pulmonary Regurgitation In Adults with repaired TEtralogy of Fallot) randomised double-blinded placebo controlled trial of ramipril therapy. More recently it has become evident that measures of left ventricular (LV) systolic and diastolic function are major predictors for mortality.
Hypothesis: The aim of this study was to provide retrospective echocardiographic analysis of patients entered into the APPROPRIATE study to further characterise degree and mechanism of LV remodeling with therapy.
Methods: Echocardiographic analysis of LV function of baseline and follow-up scans was retrospectively performed in 64 patients; 32 in the ramipril and 32 in the placebo group.
Results: There was significant difference in change in long axis shortening (1.9±4.2 mm vs -0.2±3.7 mm; p = 0.030), peak lateral systolic velocity - S’ lateral (1.0±2.0 cm/s vs -0.3±2.2 cm/s; p = 0.025), peak lateral early diastolic velocity - E’ lateral (0.57±2.4 cm/s vs -3.3±3.9 cm/s; p<0.001) and transmitral to lateral mitral annular early diastolic velocity ratio - E/E’ lateral (-0.7±1.9 vs 1.5±1.9; p<0.001) between baseline and follow-up when compared Ramipril to placebo group. LV long axis shortening (15.2±4.2 mm vs 17.0±3.1 mm; p = 0.008) improved in the Ramipril group. There was also significant worsening of the LV long axis shortening (15.1±2.8 mm vs 14.8±3.8 mm; p<0.05), E’ lateral (16.0±4.2 cm/s vs 13.0±3.0 cm/s; p = 0.001) and E/E’ lateral (5.5±1.4 vs 6.9±1.9; p = 0.003) in the placebo group. In addition, a subgroup of patients with restrictive physiology showed significant improvement in active left atrial emptying fraction (37.0±11.8 % vs 48.0±8.6 %; p = 0.043) in Ramipril arm and improvement in peak late diastolic velocity (A) (5.9±13.5 cm/s vs -5.8±12.5 cm/s; p = 0.041) and early to late diastolic transmitral velocity ratio - E/A (-0.18±0.42 vs 0.23±0.48; p = 0.037) between baseline and follow-up when Ramipril was compared to the placebo.
Conclusion: This study demonstrates that 6 months’ treatment with ramipril improves both systolic and diastolic LV function in patients with pulmonary regurgitation late after Tetralogy of Fallot repair.
Author Disclosures: S. Krupickova: None. M. Gatzoulis: None. M. Cheang: None. M. Rigby: None. A. Fraisse: None. A. Uebing: None. K. Dimopoulos: None. L. Swan: None. R. Alonso-Gonzales: None. W. Li: None. S. Babu-Narayan: None.
- © 2016 by American Heart Association, Inc.