Circulatopn:氯沙坦对法洛四联症修复术后的右心室功能障碍无治疗效果

2018-04-16 MedSci MedSci原创

血管紧张素II受体阻滞剂对右心室(RV)功能的影响尚不明确。血管紧张素II受体阻滞剂对获得性左心室功能障碍患者有益,而近期有研究提示其对系统性RV功能障碍的有症状的患者有良好的疗效。现Jouke P. Bokma等人开展实验评估氯沙坦,一种血管紧张素II受体阻滞剂,对法洛四联症修补术后的成人肺下RV功能障碍的影响进行研究。REDEFINE试验(法洛四联症的右心室功能障碍:抑制肾素-血管紧张素系统)

血管紧张素II受体阻滞剂对右心室(RV)功能的影响尚不明确。血管紧张素II受体阻滞剂对获得性左心室功能障碍患者有益,而近期有研究提示其对系统性RV功能障碍的有症状的患者有良好的疗效。现Jouke P. Bokma等人开展实验评估氯沙坦,一种血管紧张素II受体阻滞剂,对法洛四联症修补术后的成人肺下RV功能障碍的影响进行研究。

REDEFINE试验(法洛四联症的右心室功能障碍:抑制肾素-血管紧张素系统)是一个研究人员发起的、多中心的、前瞻性、随机、双盲、安慰剂为对照的研究。招募法洛四联症修补术后有RV功能障碍(RV射血分数[EF]<50%)的,但无严重瓣膜功能不全的患者。按1:1随机分至氯沙坦组(150mg/日)或安慰剂组,维持治疗18-24个月。主要结点:RV EF变化,用心血管MRI进行评估。

共招募95位患者,氯沙坦组 47人(年龄 38.0±12.4岁;74% 男性),安慰剂组 48人(40.6±11.4岁;63% 男性)。总体而言,氯沙坦和安慰剂两组患者的RV EF无明显变化(氯沙坦组[42人]44.4±5.1% 变为 45.2±5.0%;安慰剂组[46人](43.2±6.3% 变为 43.6±6.9%)。与安慰剂相比,氯沙坦并不能显着改善RV EF(+0.51%;95% CI -1.0~+2.0;p=0.50)。次要评估指标亦未见疗效差异:左心室EF、有氧运动能力和N末端前脑利钠肽(均p>0.30)。在预定义的亚组分析中,氯沙坦在有症状的、限制性RV、RV EF<40%、肺动脉瓣置换或QRS碎片化的亚组中对RV EF无统计学差异性影响。但在后分析中,氯沙坦与非限制性RV和心室重构不完全的亚组(30人)的RV EF改善相关(+2.7%;95% CI +0.1~+5.4;p=0.045)。

氯沙坦对法洛四联症修复术后的右心室功能障碍或次要疗效参数均无显着影响。

原始出处:

Jouke P. Bokma,et al.Effect of Losartan on Right Ventricular Dysfunction.Circulatopn. April 03,2018.https://doi.org/10.1161/CIRCULATIONAHA.117.031438

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    2018-08-30 liuxiaona
  4. 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  5. 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  6. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Apr 19 08:02:15 CST 2018, time=2018-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421153, encodeId=602e142115330, content=<a href='/topic/show?id=09d33294eb8' target=_blank style='color:#2F92EE;'>#功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32947, encryptionId=09d33294eb8, topicName=功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b3493649807, createdName=naiwu78, createdTime=Wed Apr 18 12:26:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421498, encodeId=e56e14214988c, content=<a href='/topic/show?id=068c6486e77' target=_blank style='color:#2F92EE;'>#法洛四联症#</a>, beContent=null, objectType=article, channel=null, level=null, 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href='/topic/show?id=e9413863070' target=_blank style='color:#2F92EE;'>#右心室功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38630, encryptionId=e9413863070, topicName=右心室功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=abfe16361765, createdName=1194695146_61857352, createdTime=Wed Apr 18 12:26:00 CST 2018, time=2018-04-18, status=1, ipAttribution=)]
    2018-04-19 zb1235672

    好知识值得拥有!

    0

  7. 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目的:评估早期服用氯沙坦能都延缓糖尿病肾病的进展。 方法:研究者对169名美国印第安人进行了长达6年的研究,所有患者为2型糖尿病,尿白蛋白/肌酐比值<300 mg/g;其中84名患者被随机分配到氯沙坦组,余下85名患者为安慰剂对照组。 主要终点为肾小球滤过率(GFR;碘酞酸盐)下降到≤60 mL/min,或基线GFR值下降一半(对于基线GFR <120 mL/min的患者)。

Circulation:氯沙坦对成人法洛四联症是否有效?

有关血管紧张素II受体阻滞剂(ARBs)对右心室(RV)功能的影响目前尚不清楚。 ARB对于获得性左心室(LV)功能障碍患者具有一定的益处,最近的一些研究结果表明,在有全身症状的RV功能障碍患者中ARBs有良好的效果。近期,一项发表在杂志Circulation上的研究旨在确定氯沙坦(losartan,一种ARB)对法洛四联症(rTOF)修复后成年人肺下RV功能不全的影响。此项研究是一项多中心前瞻性

Circ Cardiovasc Genet: FBN1基因突变:氯沙坦在马凡综合征中的疗效风向标

马凡综合征是由FBN1突变(编码原纤维蛋白1)引起的进行性疾病。目前氯沙坦被用于降低马凡综合征患者主动脉根扩张速率。因此,本研究的目的确定氯沙坦对患者增强效应。 背景:氯沙坦能够降低马凡综合征患者主动脉扩张。但是,其对治疗的回应却充满变数。本研究旨在探讨氯沙坦在遗传分类分组的有效性。 方法和结果:在研究中,马凡综合征患者每日随机服用100mg氯沙坦或者不服用氯沙坦。3年后,通过核磁共振成像

Eur Heart J:ARB剂量增加对降压效果影响不大

美国一项荟萃分析表明,血管紧张素受体拮抗剂(ARB)剂量增加对降压效果影响不大;氯沙坦的降压效果劣于其他ARB。论文8月21日在线发表于《欧洲心脏杂志》(Eur Heart J)。 研究者对Pubmed、EMBASE和Cochrane数据库进行了检索,并纳入了报告高血压患者应用ARB时24小时动态血压监测的随机临床试验。评估ARB 25%、50%和100%最大剂