This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sekuri, C. Articles by Tavli, T. Search for Related Content PubMed PubMed Citation Articles by Sekuri, C. Articles by Tavli, T. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB LOSARTAN POTASSIUM Social Bookmarking                         What's this?

Effect of losartan on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation

Kent Hospital, Department of Cardiology, Izmir, Turkey, csekuri{at}hotmail.com

Ozan Utuk

Celal Bayar University, Faculty of Medicine, Department of Cardiology, Manisa, Turkey

Ozgur Bayturan

Celal Bayar University, Faculty of Medicine, Department of Cardiology, Manisa, Turkey

Ali Bilge

Celal Bayar University, Faculty of Medicine, Department of Cardiology, Manisa, Turkey

Ziya Kurhan

Odemis State Hospital, Department of Cardiology, Odemis, Turkey

Talat Tavli

Celal Bayar University, Faculty of Medicine, Department of Cardiology, Manisa, Turkey

Objectives. The aim of this study was to assess the effects of losartan treatment on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation (MR) secondary to mitral valve prolapse or rheumatic heart disease.

Methods. Twenty-seven patients (14 males, 13 females, mean age 51±11, range 21—76) with moderate MR due to mitral valve prolapse or rheumatic heart disease were examined by means of Doppler echocardiography.The subjects were submitted to treadmill exercise tests using the modified Bruce protocol at baseline, after six hours and after the six-week treatment period to be evaluated based on their exercise tolerance. Mitral Regurgitant Volume (MRV), effective regurgitant orifice diameter, left atrial volume, left ventricle (LV) end-diastolic volume index, LV end-systolic volume index, LV ejection fraction (LVEF), left ventricle mass index were calculated at baseline and after six weeks of treatment with single dose of losartan (50 mg/day).

Results. Total treadmill exercise time increased from 477.7±147.9 to 535.7±149.0 seconds after six hours (p<0.01) and to 559.6±142.8 seconds after six weeks of treatment. Also, metabolic equivalent values increased following six hours of first dose and six weeks of losartan treatment (from 10.9±2.9 to R11.8±3.1, p=0.006 and 12.4±3.1, p=0.002; respectively). However, peak exercise systolic blood pressure (BP) was reduced after six hours and six weeks of treatment, and resting diastolic BP did not change after six hours but reduced at the end of the treatment period. MR volume decreased significantly from 29.3±14.1 ml to 25.1±14.8 ml, (p=0.025) without significant change in regurgitant orifice diameter (0.72±0.37 cm vs. 0.66±0.37 cm, p=NS), left atrium diameter and area while LVEF increased from 51.70±13.37 to 54.11—11.75 (p=0.015) with losartan.

Conclusion. We conclude that the angiotensin II receptor antagonist losartan improves exercise tolerance and echocardiographic parameters in patients with moderate MR.

Key Words: angiotensin II receptor antagonists • chronic mitral regurgitation • exercise tolerance • mitral Doppler parameters

References

• Carabello BA Mitral regurgitation, part 1: basic pathophysiologic principles. Mod Concepts Cardiovasc Dis 1988;57:53-8.[Web of Science]
• Mulieri LA, Leavitt BJ, Martin BJ, Haeberle JR, Alpert NR Myocardial force-frequency defect in mitral regurgitation heart failure is reversed by forskolin. Circulation 1994,88:2700-04.[Web of Science]
• Blumlein S., Bouchard A., Schiller NB et al. Quantitation of mitral regurgitation by Doppler echocardiography. Circulation 1986;74:306-14.[Abstract/Free Full Text]
• Rokey R., Sterling LL, Zoghbi WA et al. Determination of regurgitation fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography. J Am Coll Cardiol 1986;7:1273-8.[Abstract]
• Harshaw CW, Grossman W., Munro AB, McLaurin LP Reduced systemic vescular resistances as therapy for severe mitral regurgitation or valvular origin. Ann Intern Med 1975;83:312-16.[Abstract/Free Full Text]
• Lonn EM, Yusuf S., Jha P. et al. Emerging role of angiotensin-converting enzyme inhibitors in cardiac and vascular protection. Circulation 1994;90:2056-69.[Free Full Text]
• Braunwald E. Valvular Heart Disease. Heart Disease, A Textbook of Cardiovascular Medicine. 6th edition. Braunwald E., Zipes D., Libby P. (Eds). Philadelphia, W.B. Saunders, 2001;1653-65.
• Wisenbaugh T., Essop R., Rothlisberger C., Sareli P. Effects of a single oral dose of captopril on left ventricular performance in severe mitral regurgitation. Am J Cardiol 1992;69:348-53.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Heck I., Schmidth J., Mattern H., Fricke G., Kropp J., Reske S. Reduction of regurgitation in aortic and mitral insufficiency in acute and long-term trials. Schweiz Med Wochenscher 1985;115:1615-18.
• Schön Hr, Schröter G., Barther P., Schoming A. Quinapril therapy in patients with chronic mitral regurgitation. J Heart Valve Dis 1994;3:303-12.[Medline] [Order article via Infotrieve]
• Tischler MD, Rowan M., LeWinter MM Effect of enalapril therapy on left ventricular mass and volumes in asymptomatic, severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 1998;82:242-5.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Bruce RA Exercise testing methods and interpretations. Adv Cardiol 1978;24:6-15.[Medline] [Order article via Infotrieve]
• Tyrrell MJ, Ellison RC, Hugenholtz PG, Nadas AS Correlation of degree of left ventricular volume overload with clinical course in aortic and mitral regurgitation. Br Heart J 1970;32:683-90.[Abstract/Free Full Text]
• Wilson MG, Lim WN The natural history of rheumatic heart disease in the third, fourth, and fifth decades of life. I. Prognosis with special reference to survivorship. Circulation 1957;16:700-12.[Web of Science][Medline] [Order article via Infotrieve]
• Ling LH, Enriquez-Sarano M., Seward JB et al. Clinical outcome of mitral regurgitation due to flail lealfet. N Engl J Med 1996;335:1417-23.[Abstract/Free Full Text]
• Enriquez-Sarano M., Tajik AJ, Schaff HV, Orszulak TA, Bailey KR, Frye RL Echocardiographic prediction of survial after surgical correction of organic mitral regurgitation. Circulation 1994;90:830-7.[Abstract/Free Full Text]
• Harshaw CW, Grossman W., Munro AB, McLaurin LP Reduced systemic vascular resistance as therapy for severe mitral regurgitation of valvular origin. Ann Intern Med 1975;83:212-316.[Abstract/Free Full Text]
• Chatterjee BH, Pamley WW, Swan HJ, Berman G., Forrester J., Marcus HS Benefical effects of vasodilator agents in severe mitral regurgitation due to dysfunction of subvalvular apparatus. Circulation 1973;48:684-90.[Abstract/Free Full Text]
• Rokey R., Sterling LL, Zoghbi WA et al. Determination of regurgitant fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography. J Am Coll Cardiol 1986;7:1273-8.[Abstract]
• Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Parmley WW, Chatterjee K. Beneficial effects of hydralazine in severe mitral regurgitation. Circulation 1978;58:273-9.[Abstract/Free Full Text]
• Dell'Italia LJ The renin-angiotensin system in mitral regurgitation: a typical example of tissue activation. Curr Cardiol Rep 2002;4:97-103.[CrossRef][Medline] [Order article via Infotrieve]
• Marcotte F., Honos GN, Walling AD et al. Effect of angiotensin-converting enzyme inhibitor therapy in mitral regurgitation with normal left ventricular function. Can J Cardiol 1997;13:479-85.[Web of Science][Medline] [Order article via Infotrieve]
• Vijayalakshmi IB, Yavaqal ST, Prabhudev N. Role of echocardiography assessing the mechanism and effect of ramipril on functional mitral regurgitation in dilated cardiomyopathy. Echocardiography 2005;22:289-95.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Calabro R., Pisacane C., Pacileo G., Russo MG Hemodynamic effects of a single oral dose of enalapril among children with asymptomatic chronic mitral regurgitation. Am Heart J 1999;138:955-61.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Little WC, Zile MR, Klein A., Appleton CP, Kitzman DW, Wesley-Farrington DJ Effect of losartan and hydrochlorothiazide on exercise tolerance in exertional hypertension and left ventricular diastolic dysfunction. Am J Cardiol 2006;98:383-5.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Warner JG, Metzger DC, Kitzman DW, Wesley DJ, Little W. Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise. J Am Coll Cardiol 1999;33:1567-72.[Abstract/Free Full Text]
• Dujardin KS, Enriquez-Sarano M., Bailey KR, Seward JB, Tajik A. Effect of losartan on degree of mitral regurgitation quantified by echocardiography. Am J Cardiol 2001; 87:570-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 9, No. 2, 107-111 (2008)
DOI: 10.3317/jraas.2008.016


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sekuri, C. Articles by Tavli, T. Search for Related Content PubMed PubMed Citation Articles by Sekuri, C. Articles by Tavli, T. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB LOSARTAN POTASSIUM Social Bookmarking                         What's this?