• J. Nucl. Med. · Jun 2003

    Randomized Controlled Trial Clinical Trial

    Addition of valsartan to an angiotensin-converting enzyme inhibitor improves cardiac sympathetic nerve activity and left ventricular function in patients with congestive heart failure.

    • Shu Kasama, Takuji Toyama, Hisao Kumakura, Yoshiaki Takayama, Shuichi Ichikawa, Tadashi Suzuki, and Masahiko Kurabayashi.
    • Second Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan. s-kasama@bay.wind.ne.jp
    • J. Nucl. Med. 2003 Jun 1; 44 (6): 884-90.

    UnlabelledWe 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).MethodsThirty-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.ResultsBefore 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).ConclusionThe addition of valsartan to an ACE inhibitor improves cardiac sympathetic nerve activity, left ventricular function, and symptoms in patients with CHF.

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