Safonova Julia, Kozhevnikova Maria, Danilogorskaya Yulia, Zheleznykh Elena, Zektser Vita, Ilgisonis Irina, Popova Lyudmila, Khabarova Natalia, Privalova Elena, Belenkov Yuri
I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Cardiol Res. 2021 Dec;12(6):363-368. doi: 10.14740/cr1322. Epub 2021 Nov 5.
There is hypothesis that endothelial function enhancement is strongly associated with better outcome and functional class improvement in heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF) patients. Perindopril is the only angiotensin-converting enzyme inhibitor (ACEI) drug with proven positive effect on the endothelium in coronary artery disease (CAD) patients. In patients with HFpEF and HFmrEF, its impact is still unknown. The aim of this study was to assess perindopril's influence on endothelial dysfunction markers in these groups of patients.
We included 60 patients with HFpEF and HFmrEF. At the baseline, endothelial dysfunction biomarkers were measured by IFA and echocardiographic parameters (left atrial volume index (LAVI), ejection fraction (EF), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV)) were studied. In patients with no history of previous ACEI or angiotensin II receptor blockers (ARBs) therapy, perindopril was prescribed for 12 months. If patient was treated with ARB or ACEI drug other than perindopril before the study, after 48-h withdrawal period, previous drug was replaced by perindopril.
After 12-month therapy with perindopril, E-selectin decreased from 57.25 to 46.05 ng/mL and from 56.55 to 47.6 ng/mL in HFpEF and HFmrEF patients, respectively (P < 0.05). Significant reductions from 0.99 to 0.76 pg/mL (P < 0.05) and from 1.08 to 0.97 pg/mL (P < 0.05) in endothelin-1 level were shown in patients with HFpEF and HFmrEF.
The 12-month therapy with perindopril leads to LAVI reduction in HFmrEF patients and potential endothelial dysfunction markers decrease in HFpEF and HFmrEF patients.
有假说认为，在射血分数保留的心力衰竭（HFpEF）和射血分数中等范围的心力衰竭（HFmrEF）患者中，内皮功能增强与更好的预后及功能分级改善密切相关。培哚普利是唯一一种在冠状动脉疾病（CAD）患者中已证实对内皮有积极作用的血管紧张素转换酶抑制剂（ACEI）药物。在HFpEF和HFmrEF患者中，其影响仍不明确。本研究的目的是评估培哚普利对这些患者群体内皮功能障碍标志物的影响。
我们纳入了60例HFpEF和HFmrEF患者。在基线时，通过免疫荧光分析法测量内皮功能障碍生物标志物，并研究超声心动图参数（左心房容积指数（LAVI）、射血分数（EF）、左心室质量指数（LVMI）、左心室舒张末期直径（LVEDD）和左心室舒张末期容积（LVEDV））。对于既往无ACEI或血管紧张素II受体阻滞剂（ARB）治疗史的患者，给予培哚普利治疗12个月。如果患者在研究前接受过除培哚普利以外的ARB或ACEI药物治疗，在停药48小时后，将先前的药物替换为培哚普利。
培哚普利治疗12个月后，HFpEF和HFmrEF患者的E-选择素分别从57.25 ng/mL降至46.05 ng/mL和从56.55 ng/mL降至47.6 ng/mL（P<0.05）。HFpEF和HFmrEF患者的内皮素-1水平分别从0.99 pg/mL显著降至0.76 pg/mL（P<0.05）和从1.08 pg/mL降至0.97 pg/mL（P<0.05）。
培哚普利治疗12个月可使HFmrEF患者的LAVI降低，并使HFpEF和HFmrEF患者潜在的内皮功能障碍标志物减少。
