Document Detail

Addition of valsartan to an angiotensin-converting enzyme inhibitor improves cardiac sympathetic nerve activity and left ventricular function in patients with congestive heart failure.
MedLine Citation:
PMID:  12791814     Owner:  NLM     Status:  MEDLINE    
We determined whether the addition of the angiotensin-receptor blocker valsartan to an angiotensin-converting enzyme (ACE) inhibitor improves cardiac sympathetic nerve activity and left ventricular function in patients with congestive heart failure (CHF). METHODS: Thirty-two patients with CHF (left ventricular ejection fraction [LVEF] < 40%; mean, 33% +/- 6%) were treated with an ACE inhibitor and a loop diuretic. Sixteen patients (group A) were randomized to additionally receive valsartan (40-80 mg/d), and the remaining 16 patients (group B) continued their current regimen. Patients were studied before and 6 mo after treatment. The delayed heart-to-mediastinum count ratio (H/M ratio), delayed total defect score (TDS), and washout rate (WR) were determined from (123)I-metaiodobenzylguanidine images. The left ventricular end-diastolic volume (LVEDV) and LVEF were determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated. RESULTS: Before treatment, TDS, H/M ratio, WR, LVEDV, LVEF, and NYHA functional class were similar in both groups. After treatment in group A, TDS decreased from 37 +/- 8 to 31 +/- 9 (P < 0.001), H/M ratio increased from 1.66 +/- 0.23 to 1.81 +/- 0.23 (P < 0.001), and WR decreased from 47% +/- 9% to 39% +/- 10% (P < 0.01). In addition, the LVEDV decreased from 193 +/- 36 mL to 169 +/- 51 mL (P < 0.005), and LVEF increased from 32% +/- 7% to 41% +/- 13% (P = 0.0005). In group B, these parameters did not change significantly. NYHA functional class improved in both groups (in group A, from 3.3 +/- 0.5 to 1.7 +/- 0.6 [P < 0.0005]; in group B, from 3.3 +/- 0.5 to 2.4 +/- 0.6; [P < 0.005]). The improvement was significantly greater in group A than in group B (P < 0.05). CONCLUSION: The addition of valsartan to an ACE inhibitor improves cardiac sympathetic nerve activity, left ventricular function, and symptoms in patients with CHF.
Shu Kasama; Takuji Toyama; Hisao Kumakura; Yoshiaki Takayama; Shuichi Ichikawa; Tadashi Suzuki; Masahiko Kurabayashi
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of nuclear medicine : official publication, Society of Nuclear Medicine     Volume:  44     ISSN:  0161-5505     ISO Abbreviation:  J. Nucl. Med.     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-06     Completed Date:  2003-07-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0217410     Medline TA:  J Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  884-90     Citation Subset:  IM    
Second Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan.
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MeSH Terms
3-Iodobenzylguanidine / diagnostic use
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
Drug Synergism
Drug Therapy, Combination
Heart Failure / complications,  drug therapy*,  radionuclide imaging,  ultrasonography
Heart Ventricles / drug effects,  innervation,  radionuclide imaging
Middle Aged
Radiopharmaceuticals / diagnostic use
Stroke Volume
Sympathetic Nervous System / drug effects*,  radionuclide imaging
Tetrazoles / administration & dosage*
Treatment Outcome
Valine / administration & dosage*,  analogs & derivatives*
Ventricular Dysfunction, Left / drug therapy*,  etiology,  ultrasonography
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Radiopharmaceuticals; 0/Tetrazoles; 137862-53-4/valsartan; 7004-03-7/Valine; 77679-27-7/3-Iodobenzylguanidine

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