HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) All Versions of this Article: hrt.2007.117978v1 94/5/573    most recent Submit a response Read responses to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Yip, G W K Articles by Sanderson, J E PubMed PubMed Citation Articles by Yip, G W K Articles by Sanderson, J E

The Hong Kong diastolic heart failure study: a randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction

¹ Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR
² Department of Medicine, Yan Chai Hospital, Hong Kong SAR
³ Department of Medicine, Princess Margaret Hospital, Hong Kong SAR
⁴ Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR

Correspondence to:
Professor John Sanderson, Department of Cardiovascular Medicine, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT; j.e.sanderson{at}bham.ac.uk

ABSTRACT
Background: Although heart failure with a preserved or normal ejection fraction (HFNEF or diastolic heart failure) is common, treatment outcomes on quality of life and cardiac function are lacking. The effect of renin–angiotensin blockade by irbesartan or ramipril in combination with diuretics on quality of life (QoL), regional and global systolic and diastolic function was assessed in HFNEF patients.

Methods: 150 patients with HFNEF (LVEF >45%) were randomised to (1) diuretics alone, (2) diuretics plus irbesartan, or (3) diuretics plus ramipril. QoL, 6-minute walk test (6MWT) and Doppler echocardiography were performed at baseline, 12, 24 and 52 weeks.

Results: The QoL score improved similarly in all three groups by 52 weeks (–46%, 51%, and 50% respectively, all p<0.01), although 6MWT increased only slightly (average +3–6%). Recurrent hospitalisation rates were equal in all groups (10–12% in 1 year). At 1 year, LV dimensions or LVEF had not changed in any group, though both systolic and diastolic blood pressures were lowered in all three groups from 4 weeks onwards. At baseline both mean peak systolic (Sm) and early diastolic (Em) mitral annulus velocities were reduced, and increased slightly in the diuretic plus irbesartan (Sm 4.5 (SEM 0.17) to 4.9 (SEM 0.16) cm/sec; Em 3.8 (SEM 0.25) to 4.2 (SEM 0.25) cm/sec) and ramipril (Sm 4.5 (SEM 0.24) to 4.9 (SEM 0.20) cm/sec; Em 3.3 (SEM 0.25) to 4.04 (SEM 0.32) cm/sec) groups (both p<0.05). NT-pro-BNP levels were raised at baseline (595 (SD 905) pg/ml; range 5–4748) and fell in the irbesartan (–124 (SD 302) pg/ml, p = 0.01) and ramipril (–173 (SD 415) pg/ml, p = 0.03) groups only.

Conclusions: In this typically elderly group of HF patients with normal LVEF, diuretic therapy significantly improved symptoms and neither irbesartan nor ramipril had a significant additional effect. However, diuretics in combination with irbesartan or ramipril marginally improved LV systolic and diastolic longitudinal LV function, and lowered NT-proBNP over 1 year.

This article has been cited by other articles:

				A. A Voors and R. M de Jong Treating diastolic heart failure Heart, August 1, 2008; 94(8): 971 - 972. [Full Text] [PDF]

eLetters: