Beneficial effects of ramipril on myocardial diastolic function in patients with type 2 diabetes mellitus – a prospective pilot study in comparison to matched control individuals

Background/aims: Treatment with ACE-inhibitors is an important factor within multi-modal strategies to improve cardiovascular outcome for patients with type 2 diabetes mellitus (T2DM). Myocardial function may have the potential to serve as an immediate indicator in the assessment of preventive therapy if evaluated by a sensitive technology such as tissue Doppler which quantifies diastolic myocardial function, known to have important prognostic relevance. Consequently, the hypothesis was tested, that treatment with ramipril (R) has beneficial effects on myocardial diastolic function in T2DM.

Methods: In this prospective study, we evaluated 16 participants on insulin therapy (52±8yrs), with normal systolic ventricular function over 9 months. 8 patients were treated with 10mg R (duration of diabetes 9±6yrs, BMI 29±1, HbA1c 6.9±1.1%) to be compared to 8 age-matched controls without ACE-inhibition (duration of diabetes 10±6yrs, BMI 30±1, HbA1c 6.3±1.1%). Myocardial function was assessed by echocardiography with special attention to tissue Doppler.

Results: In the R group, diastolic myocardial function (Ve) significantly improved after 9 months (7.8±0.9cm/s to 8.6±0.9, p<0.044). Already after 6 weeks, there was a tendency towards improvement (7.8±0.9cm/s vs. 8.3±0.9, p<0.069). Blood pressure improved, not significantly, from 139mmHg±18 to 127mmHg±10, p=0.13. In the control group, blood pressure remained unaltered (135mmHg±10 to 137mmHg±13, p=0.78) and so did Ve. Systolic function (Vs) and late diastolic function (Va) remained unaltered in both groups, so did metabolic parameters like HbA1c, fasting glucose, serum insulin, HOMA, CRP, triglycerides, total- LDL- and HDL-cholesterol.

Conclusions: The augmented diastolic myocardial function with ramipril 10mg as measured by tissue Doppler is an encouraging result for patients with T2DM facing the well known prognostic value of diastolic dysfunction. It may be speculated, that the observed functional improvement may have contributed to the reported improvement of hard cardiovascular end points.