Servei de Cardiologia, Hospital Universitari Vall d'Hebron, CIBERCV, Barcelona, Spain. Electronic address: https://twitter.com/giselateixido.
Hospital Puerta de Hierro, Majadahonda, Spain.
J Am Coll Cardiol. 2018 Oct 2;72(14):1613-1618. doi: 10.1016/j.jacc.2018.07.052.
Beta-blockers are the standard treatment in Marfan syndrome (MFS). Recent clinical trials with limited follow-up yielded conflicting results on losartan's effectiveness in MFS.
The present study aimed to evaluate the benefit of losartan compared with atenolol for the prevention of aortic dilation and complications in Marfan patients over a longer observation period (>5 years).
A total of 128 patients included in the previous LOAT (LOsartan vs ATenolol) clinical trial (64 in the atenolol and 64 in the losartan group) were followed up for an open-label extension of the study, with the initial treatment maintained.
Mean clinical follow-up was 6.7 ± 1.5 years. A total of 9 events (14.1%) occurred in the losartan group and 12 (18.8%) in the atenolol group. Survival analysis showed no differences in the combined endpoint of need for aortic surgery, aortic dissection, or death (p = 0.462). Aortic root diameter increased with no differences between groups: 0.4 mm/year (95% confidence interval: 0.2 to 0.5) in the losartan and 0.4 mm/year (95% confidence interval: 0.3 to 0.6) in the atenolol group. In the subgroup analyses, no significant differences were observed considering age, baseline aortic root diameter, or type of dominant negative versus haploinsufficient FBN1 mutation.
Long-term outcome of Marfan syndrome patients randomly assigned to losartan or atenolol showed no differences in aortic dilation rate or presence of clinical events between treatment groups. Therefore, losartan might be a useful, low-risk alternative to beta-blockers in the long-term management of these patients.
β受体阻滞剂是马凡综合征（MFS）的标准治疗方法。最近的临床试验随访时间有限，其结果在氯沙坦治疗 MFS 的有效性方面存在矛盾。
本研究旨在评估氯沙坦与阿替洛尔相比，在较长观察期（>5 年）内预防马凡综合征患者主动脉扩张和并发症的疗效。
共有 128 例患者纳入之前的 LOAT（氯沙坦与阿替洛尔）临床试验（阿替洛尔组 64 例，氯沙坦组 64 例），进行研究的开放性延伸随访，初始治疗维持不变。
平均临床随访时间为 6.7±1.5 年。氯沙坦组发生 9 例（14.1%）事件，阿替洛尔组发生 12 例（18.8%）事件。生存分析显示主动脉手术、主动脉夹层或死亡的联合终点无差异（p=0.462）。主动脉根部直径增加，两组之间无差异：氯沙坦组 0.4mm/年（95%可信区间：0.2 至 0.5），阿替洛尔组 0.4mm/年（95%可信区间：0.3 至 0.6）。亚组分析显示，考虑年龄、基线主动脉根部直径或显性负性与半合子不足 FBN1 突变类型，两组间无显著差异。
随机分配至氯沙坦或阿替洛尔的马凡综合征患者的长期结局显示，两组间主动脉扩张率或临床事件发生率无差异。因此，氯沙坦可能是这些患者长期治疗的一种有用、低风险的β受体阻滞剂替代药物。
