Correction of deranged systolic and diastolic left ventricular function inpatients with congestive heart failure by long-acting preparation of isosorbide-5-mononitrate

Doppler echocardiography was used for the study of effects of a long-acting preparation of isosorbide-5-mononitrate (5 mg o.d.) on parameters of cardi ac systolic and diastolic function and pulmonary artery pressure in 30 pati ents with ischemic heart disease and congestive heart failure. In 86,7% of patients treatment was associated with diminution of clinical signs of hear t failure, reduction of initially elevated right ventricular end-diastolic dimension (p<0,05), left ventricular end diastolic and end systolic volumes (p<0,05 and p<0,001, respectively), and pulmonary artery pressure (p<0,05) , augmentation of stroke volume (p<0,05) and velocity of left ventricular c ircumferential fiber shortening (p<0,05). Course treatment with long acting isosorbide-5-mononitrate produced peculiar modulating effect on left ventr icular diastolic function which depended on the type of its primary disturb ance and the stage of heart failure. In patients with stage I heart failure and slowed left ventricular relaxation occurred relative increase of peak velocity of early transmitral diastolic flow (p<0.05) and restoration of no rmal early to late diastolic filling ratio (p<0,001). In patients with stag e II-IIIA heart failure and initially high values of left ventricular end d iastolic and left atrial pressures use of isosorbide-5-mononitrate was asso ciated with transformation of <<restrictive>> type of diastolic left ventri cular dysfunction into prognostically more favorable type with <<slowed rel axation>>. This transformation resulted in lowering of pathologically eleva ted velocity of early (Peak E) and increase of velocity of late (Peak A) le ft ventricular filling.