Cor Vasa 2006, 48(11):403-407

Managing diastolic heart failure. Results of PEP-CHF

Jiří Widimský

Klinika kardiologie, Institut klinické a experimentální medicíny, Subkatedra kardiologie IPVZ, Praha, Česká republika

PEP-CHF (Perindopril in Elderly People with Chronic Heart Failure) was a one-year, randomised, double-blind study comparing the effects of the ACE inhibitor perindopril and placebo on mortality and morbitidy in elderly patients with chronic heart failure secondary to diastolic left ventricular dysfunction. This was the first study of chronic heart failure assessing diastolic left ventricular dysfunction by echocardiography. The study included 850 patients with a mean age of 76 years. It included cases of mild to moderate chronic heart failure, as most patients (74-77%) were classified in NYHA Class II/I, as also reflected by low overall mortality rates. Enrollment of patients into the study was more difficult and slower than expected. Left atrial dilatation and left ventricular hypertrophy were present in more than 75% of patients. Plasma NT-proBNP levels were not appreciably increased.
After one year, when most patients were on randomised therapy, perindopril demonstrated symptoms improvement and increased exercise tolerance, a decrease in the number of unplanned hospitalisations by 37%, and a decrease in the combined primary endpoint (overall mortality and hospitalisations for heart failure) by 31% at bordeline significance. Likewise, perindopril reduced the number of hospital bed-days for overall or cardiovascular reasons. In the subgroup analysis, perindopril has been shown to be more effective in reducing rates of hospitalisation for heart failure in patients ≤ 75 of age, in patients after myocardial infarction, and in those with systolic blood pressure > 140 mm Hg. Likewise, perindopril resulted in significantly improved NYHA classification and, also, significantly improved 6-minute walking test at 52 weeks. The levels of NT-proBNP showed a tendency toward a decrease in perindopril-treated patients, while there was no change in the placebo group. The incidence of the primary endpoint was three times greater than in patients with NT-proBNP levels higher than the median of the present study.
NT-proBNP is a prognostic marker not only of systolic but, also, of diastolic heart failure. Natriuretic peptides might be more objective markers of left ventricular dysfunction than echocardiography future studies.

Keywords: Diastolic heart failure; Perindopril; Diastolic dysfunction

Published: November 1, 2006  Show citation