Angiotensin receptor blockade and exercise capacity in adults with systemic right ventricles - A multicenter, randomized, placebo-controlled clinical trial

Article

关键词: CHRONIC HEART-FAILURE;    NATRIURETIC PEPTIDE;    MUSTARD OPERATION;    SYSTOLIC FUNCTION;    ATRIAL REPAIR;    NT-PROBNP;    TRANSPOSITION;    CAPTOPRIL;    PERFORMANCE;    DYSFUNCTION;   

DOI  :  10.1161/CIRCULATIONAHA.105.543470

来源: SCIE

【 摘 要 】

Background - Pharmacological blockade of the renin-angiotensin system improves exercise tolerance in patients with left ventricular dysfunction, yet its impact on patients with systemic right ventricles (RVs) remains unknown Methods and Results - A multicenter, randomized, double-blind, placebo-controlled, crossover clinical trial was performed to assess the effects of losartan on exercise capacity and neurohormonal levels in patients with systemic RVs. Of 29 patients studied ( age, 30.3 +/- 10.9 years), 21 had transposition of the great arteries with a Mustard baffle, and 8 had congenitally corrected transposition of the great arteries. Baseline values were as follows: Vo(2)max, 29.8 +/- 5.6 mL (.) kg(-1) (.) min(-1) (73.5 +/- 12.9% predicted value); RV ejection fraction, 41.6 +/- 9.3%; N-terminal pro brain natriuretic peptide (NT-proBNP), 257.7 +/- 243.4 pg/mL ( normal < 125 pg/mL); and angiotensin II, 5.7 +/- 4.9 pg/mL ( normal < 5.0 pg/mL). Comparing losartan to placebo showed no differences in Vo(2)max (29.9 +/- 5.4 versus 29.4 +/- 6.2 mL (.) kg(-1 .) min(-1); P = 0.43), exercise duration (632.3 +/- 123.0 versus 629.9 +/- 140.7 seconds; P = 0.76), and NT-proBNP levels (201.2 +/- 267.8 versus 229.7 +/- 291.5 pg/mL; P = 0.10), despite a trend toward increased angiotensin II levels (15.2 +/- 13.8 versus 8.8 +/- 12.5 pg/mL; P = 0.08). Conclusions - In adults with systemic RVs, losartan did not improve exercise capacity or reduce NT-proBNP levels. Minimal baseline activation of the renin-angiotensin system may explain this lack of benefit and imply an alternative pathophysiological mechanism for the progressive ventricular dysfunction and impaired exercise capacity observed in such patients.

【 授权许可】

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