CardiomyopathyEffect of Losartan on Left Ventricular Diastolic Function in Patients With Nonobstructive Hypertrophic Cardiomyopathy
Section snippets
Selection of participants
The study subjects were consecutively recruited from the HC ambulatory center of the Heart Institute of the University of Sao Paulo Medical School, a university tertiary referral center. The elected patients fulfilled the entry criteria, which were as follows: established clinical diagnosis of HC supported by echocardiographic left ventricular (LV) wall thickness ≥15 mm, age 18 to 50 years, sinus rhythm, normal blood pressure (upper limit 140/90 mm Hg), a normal LV ejection fraction, and the
Results
Table 1 lists baseline characteristics of the study population. There were no significant differences in categorical and numerical variables between treated and nontreated groups on entry into the study. A large proportion of patients were symptomatic, which can be ascribed to the selected pattern of this HC population. Overall, the largest obtained LV outflow peak gradient at rest was 24 mm Hg. Using 30 mm as the cut-off value for massive hypertrophy, the mean interventricular septum thickness
Discussion
In this study, symptomatic improvement, left atrial diameter reduction, Doppler changes, and plasma NT–pro-BNP reduction were concordant findings, suggesting that angiotensin II antagonism with losartan was able to induce the amelioration of LV diastolic dysfunction in our patients with HC. The reported symptomatic reduction needs to be interpreted with caution, because a placebo effect cannot be ruled out. Left atrial enlargement has been associated with chronic diastolic dysfunction,12 and
References (22)
- et al.
Comparison of the effects of losartan and enalapril on clinical status and exercise performance in patients with moderate or severe heart failure
J Am Coll Cardiol
(1995) - et al.
Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial: the Losartan Heart Failure Survival Study ELITE II
Lancet
(2000) - et al.
Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography
J Am Soc Echocardiogr
(1996) - et al.
Plasma NT-proBNP is elevated in adults with sickle cell disease without clinical heart failure
J Card Fail
(2004) The left atriuma biomarker of chronic diastolic dysfunction and cardiovascular disease risk
J Am Coll Cardiol
(2003)- et al.
New Doppler echocardiographic applications for the study of diastolic function
J Am Coll Cardiol
(1998) - et al.
Doppler tissue imaginga noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures
J Am Coll Cardiol
(1997) - et al.
Angiotensin II has multiple profibrotic effects in human cardiac fibroblasts
Circulation
(2000) - et al.
Comparative effects of chronic angiotensin-converting enzyme inhibition and angiotensin II type 1 receptor blockade on cardiac remodeling after myocardial infarction in the rat
Circulation
(1994) - et al.
Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients
Circulation
(2002)
Influence of the angiotensin II antagonist valsartan on left ventricular hypertrophy in patients with essential hypertension
Circulation
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