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Angiotensin-converting enzyme (ACE) inhibitors revert abnormal right ventricular filling in patients with restrictive left ventricular disease

^a Royal Brompton Hospital, London, England, United Kingdom

View larger version (33K): [in a new window]   Figure 1 A composite of the transmitral and transtricuspid pulsed-Doppler flow and RV, long axis from a patient before ACE-I (left) and with ACE-I (right). Note the restrictive mitral filling pattern before treatment and its regression with ACE-I. There is no significant change in RV long axis motion with treatment, but tricuspid flow starts earlier and the extent of incoordinate RV ring motion falls. Continuous vertical lines represent A2 and dotted vertical lines represent the onset of tricuspid flow. Calibration: velocity 20 cm·s–1; depth 1 cm; time 40 and 200 ms, respectively.

View larger version (19K): [in a new window]   Figure 2 A plot in individual patients of transmitral E wave acceleration rate versus the time interval between P2 and the onset of tricuspid flow. Note the consistent fall of the former coinciding with shortening in the latter in all patients. Closed circles = patients under control condition; open circles = after treatment.