Moura Luis M, Ramos Sandra F, Kristensen Steen D, Pinto Fausto J, Barros Isabel M, Rocha-Gonçalves Francisco
Department of Medicine, Oporto School of Medicine, University of Oporto, Portugal.
J Heart Valve Dis. 2012 Jul;21(4):463-72.
The study aims were to test the effect of rosuvastatin on the progression of left ventricular (LV) diastolic function in patients with aortic stenosis (AS), and to evaluate the use of beta-natriuretic-peptide (BNP) as a marker of diastolic dysfunction in this condition.
Sixty-one hypercholesterolemic, consecutive new referrals with moderate AS were administered rosuvastatin (Crestor) 20 mg/day for 18 months, while a further 60 subjects with normal cholesterol levels remained untreated. The LV diastolic function was determined using conventional Doppler echocardiography, tissue Doppler imaging (TDI); BNP plasma levels were monitored when subjects entered the study and then assessed prospectively at six-month intervals until the study end.
After an 18-month (mean 73 +/- 24 weeks) period of treatment with rosuvastatin (Tx group), patients showed a significantly better diastolic function than untreated subjects (uTx group), as indicated by an isovolumic relaxation time (IVRT) (Tx 102.0 +/- 42.8 versus 97.2 +/- 19.1; p < 0.001; uTx 99.7 +/- 21.7 versus 95.2 +/- 21.8 ms; p = 0.032), E/A ratio (Tx 1.0 +/- 0.6 versus 0.9 +/- 0.3, p = 0.52; uTx 1.2 +/- 0.40 versus 0.9 +/- 0.30 versus, p = 0.006), and E/E' ratio (Tx 11.4 +/- 1.5 versus 11.4 +/- 1.8, p = 0.19; uTx 15.4 +/- 1.2 versus 12.3 +/- 1.5, p < 0.001). Similarly, at study end, plasma levels of BNP were significantly lower in the Tx group than in the uTx group [median (1st-3rd quartiles): 37.0 pg/ml (20.1-65.2 pg/ml) versus 57.1 pg/ml (46.9-98.2 pg/ml); p = 0.017].
The results of this prospective follow up study of asymptomatic patients showed that rosuvastatin treatment delays the progression of diastolic dysfunction in moderate AS when assessed using hemodynamic echocardiographic parameters or by the release of plasma physiological markers. Hence, the benefits of statin treatment in AS, which are known to affect the valve endothelium, also extend to changes affecting myocardial function itself.
本研究旨在测试瑞舒伐他汀对主动脉瓣狭窄（AS）患者左心室（LV）舒张功能进展的影响，并评估使用脑钠肽（BNP）作为该病症舒张功能障碍标志物的效用。
61例新确诊的中度AS高胆固醇血症患者连续接受瑞舒伐他汀（可定）20mg/天治疗18个月，另外60例胆固醇水平正常的受试者未接受治疗。使用传统多普勒超声心动图、组织多普勒成像（TDI）测定左心室舒张功能；受试者在进入研究时监测血浆BNP水平，然后每隔6个月进行前瞻性评估直至研究结束。
经过18个月（平均73±24周）的瑞舒伐他汀治疗期（治疗组），患者的舒张功能明显优于未治疗的受试者（未治疗组），等容舒张时间（IVRT）表明了这一点（治疗组102.0±42.8对97.2±19.1；p<0.001；未治疗组99.7±21.7对95.2±21.8毫秒；p = 0.032），E/A比值（治疗组1.0±0.6对0.9±0.3，p = 0.52；未治疗组1.2±0.40对0.9±0.30，p = 0.006），以及E/E'比值（治疗组11.4±1.5对11.4±1.8，p = 0.19；未治疗组15.4±1.2对12.3±1.5，p<0.001）。同样，在研究结束时，治疗组的血浆BNP水平显著低于未治疗组[中位数（第1-3四分位数）：37.0pg/ml（20.1-65.2pg/ml）对57.1pg/ml（46.9-98.2pg/ml）；p = 0.017]。
这项对无症状患者的前瞻性随访研究结果表明，当使用血流动力学超声心动图参数或血浆生理标志物释放进行评估时，瑞舒伐他汀治疗可延缓中度AS患者舒张功能障碍的进展。因此，已知他汀类药物治疗对AS瓣膜内皮有影响，其益处也扩展到对心肌功能本身的改变。
