Sekuri Cevad, Utuk Ozan, Bayturan Ozgur, Bilge Ali, Kurhan Ziya, Tavli Talat
Kent Hospital, Department of Cardiology, Izmir, Turkey.
J Renin Angiotensin Aldosterone Syst. 2008 Jun;9(2):107-11. doi: 10.3317/jraas.2008.016.
The aim of this study was to assess the effects of losartan treatment on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation (MR) secondary to mitral valve prolapse or rheumatic heart disease.
Twenty-seven patients (14 males, 13 females, mean age 51+/-11, range 21-76) with moderate MR due to mitral valve prolapse or rheumatic heart disease were examined by means of Doppler echocardiography. The subjects were submitted to treadmill exercise tests using the modified Bruce protocol at baseline, after six hours and after the six-week treatment period to be evaluated based on their exercise tolerance. Mitral Regurgitant Volume (MRV), effective regurgitant orifice diameter, left atrial volume, left ventricle (LV) end-diastolic volume index, LV end-systolic volume index, LV ejection fraction (LVEF), left ventricle mass index were calculated at baseline and after six weeks of treatment with single dose of losartan (50 mg/day).
Total treadmill exercise time increased from 477.7+/-147.9 to 535.7+/-149.0 seconds after six hours (p<0.01) and to 559.6+/-142.8 seconds after six weeks of treatment. Also, metabolic equivalent values increased following six hours of first dose and six weeks of losartan treatment (from 10.9+/-2.9 to 11.8+/-3.1, p=0.006 and 12.4+/-3.1, p=0.002; respectively). However, peak exercise systolic blood pressure (BP) was reduced after six hours and six weeks of treatment, and resting diastolic BP did not change after six hours but reduced at the end of the treatment period. MR volume decreased significantly from 29.3+/-14.1 ml to 25.1+/-14.8 ml, (p=0.025) without significant change in regurgitant orifice diameter (0.72+/-0.37 cm vs. 0.66+/-0.37 cm, p=NS), left atrium diameter and area while LVEF increased from 51.70+/-13.37 to 54.11-11.75 (p=0.015) with losartan.
We conclude that the angiotensin II receptor antagonist losartan improves exercise tolerance and echocardiographic parameters in patients with moderate MR.
本研究旨在评估氯沙坦治疗对二尖瓣脱垂或风湿性心脏病继发二尖瓣反流（MR）患者运动耐量及超声心动图参数的影响。
对27例（14例男性，13例女性，平均年龄51±11岁，范围21 - 76岁）因二尖瓣脱垂或风湿性心脏病导致中度MR的患者进行多普勒超声心动图检查。受试者在基线、6小时后及6周治疗期结束后，采用改良Bruce方案进行平板运动试验，根据运动耐量进行评估。在基线及单剂量氯沙坦（50mg/天）治疗6周后，计算二尖瓣反流容积（MRV）、有效反流口直径、左心房容积、左心室（LV）舒张末期容积指数、LV收缩末期容积指数、LV射血分数（LVEF）、左心室质量指数。
6小时后平板运动总时间从477.7±147.9秒增加至535.7±149.0秒（p<0.01），治疗6周后增加至559.6±142.8秒。同样，首剂用药6小时及氯沙坦治疗6周后，代谢当量值增加（分别从10.9±2.9增至到11.8±3.1，p = 0.006；从11.8±3.1增至到12.4±3.1，p = 0.002）。然而，治疗6小时及6周后运动高峰收缩压（BP）降低，静息舒张压6小时后未改变，但在治疗期末降低。MR容积从29.3±14.1ml显著降至25.1±14.8ml（p = 0.025），反流口直径（0.72±0.37cm对0.66±0.37cm，p = NS）、左心房直径及面积无显著变化，而氯沙坦治疗后LVEF从51.70±13.37增至54.11 - 11.75（p = 0.015）。
我们得出结论，血管紧张素II受体拮抗剂氯沙坦可改善中度MR患者的运动耐量及超声心动图参数。
