氯沙坦可改善缺血性心肌病所致心力衰竭患者的心率变异性和心率震荡。

Losartan improves heart rate variability and heart rate turbulence in heart failure due to ischemic cardiomyopathy.

作者信息

Ozdemir Murat, Arslan Uğur, Türkoğlu Sedat, Balcioğlu Serhat, Cengel Atiye

机构信息

Gazi University School of Medicine, Department of Cardiology, Ankara, Turkey.

出版信息

J Card Fail. 2007 Dec;13(10):812-7. doi: 10.1016/j.cardfail.2007.08.002.

DOI:10.1016/j.cardfail.2007.08.002

PMID:18068613

Abstract

BACKGROUND

Heart rate variability (HRV) and heart rate turbulence are known to be disturbed and associated with excess mortality in heart failure. The aim of this study was to investigate whether losartan, when added on top of beta-blocker and angiotensin-converting enzyme inhibitor (ACEI) therapy, could improve these indices in patients with systolic heart failure.

METHODS AND RESULTS

Seventy-seven patients (mean age 60.4 +/- 8.0, 80.5% male) with ischemic cardiomyopathy (mean ejection fraction 34.5 +/- 4.4%) and New York Heart Association Class II-III heart failure symptoms, already receiving a beta-blocker and an ACEI, were randomly assigned to either open-label losartan (losartan group) or no additional drug (control group) in a 2:1 ratio and the patients were followed for 12 weeks. The HRV and heart rate turbulence indices were calculated from 24-hour Holter recordings both at the beginning and at the end of follow-up. The baseline clinical characteristics, HRV, and heart rate turbulence indices were similar in the 2 groups. At 12 weeks of follow-up, all HRV parameters except pNN50 increased (SDNN: 113.2 +/- 34.2 versus 127.8 +/- 24.1, P = .001; SDANN: 101.5 +/- 31.7 versus 115.2 +/- 22.0, P = .001; triangular index: 29.9 +/- 11.1 versus 34.2 +/- 7.9, P = .008; RMSSD: 29.1 +/- 20.2 versus 34.3 +/- 23.0, P = .009; NN50: 5015.3 +/- 5554.9 versus 6446.7 +/- 6101.1, P = .024; NN50: 5.65 +/- 6.41 versus 7.24 +/- 6.99, P = .089; SDNNi: 45.1 +/- 13.3 versus 50.3 +/- 14.5, P = .004), turbulence onset decreased (-0. 61 +/- 1.70 versus -1.24 +/- 1.31, P = .003) and turbulence slope increased (4.107 +/- 3.881 versus 5.940 +/- 4.281, P = .004) significantly in the losartan group as compared with controls.

CONCLUSIONS

A 12-week-long losartan therapy significantly improved HRV and heart rate turbulence in patients with Class II-III heart failure and ischemic cardiomyopathy already on beta-blockers and ACEI.

摘要

背景

已知心率变异性（HRV）和心率震荡在心力衰竭时会受到干扰并与死亡率增加相关。本研究的目的是调查在β受体阻滞剂和血管紧张素转换酶抑制剂（ACEI）治疗基础上加用氯沙坦是否能改善收缩性心力衰竭患者的这些指标。

方法与结果

77例（平均年龄60.4±8.0岁，80.5%为男性）缺血性心肌病（平均射血分数34.5±4.4%）且有纽约心脏协会II - III级心力衰竭症状、已接受β受体阻滞剂和ACEI治疗的患者，按2:1比例随机分为开放标签的氯沙坦组（氯沙坦组）或不添加其他药物的对照组，对患者随访12周。在随访开始和结束时均通过24小时动态心电图记录计算HRV和心率震荡指标。两组的基线临床特征、HRV和心率震荡指标相似。随访12周时，氯沙坦组除pNN50外的所有HRV参数均升高（SDNN：113.2±34.2对127.8±24.1，P = 0.001；SDANN：101.5±31.7对115.2±22.0，P = 0.001；三角指数：29.9±11.1对34.2±7.9，P = 0.008；RMSSD：29.1±20.2对34.3±23.0，P = 0.009；NN50：5015.3±5554.9对6446.7±6101.1，P = 0.024；NN50：5.65±6.41对7.24±6.99，P = 0.089；SDNNi：45.1±13.3对50.3±14.5，P = 0.004），震荡起始降低（-0.61±1.70对-1.24±1.31，P = 0.003），震荡斜率增加（4.107±3.881对5.940±4.281，P = 0.004），与对照组相比有显著差异。