| BackgroundCongestive heart failure (CHF) is a popular clinical syndrome with higher morbidity and poorprognosis. Endothe1ial dysfunction plays important roles in the pathophysiology of CHF accordingthe recently research. Study of ELITE (Evaluation of Losaftan in The Elderly ) proved thatangiotensin II type l (ATl) receptor antagonist Losartan improved hemodynamic parameters,reduced morbidity and mortality in CHF. However, whether Losartan attributed to endotheliafunction in patients with CHF is still unknown.ObjectiveThe aim of this study was to investigate whether CHF itse1f is an independeflt endotheliumrisk factor of endothelium dysfunction in patients with congestive heart failure (CHF) and toelucidate the influence of the ATl amagonist (Losartan) on it.MetbodsWe investigated 25 patients with CHF(age 65 ~ 90, 76 l 7 Mean+SD) who had been treatedwith diuretic, digoxin or nitrovasodilators and still with signature such as short of breathes, NewYork Heart Association functional class was Il~IV and L%rEF <0.50, 23 coronary artery disease(CAD) patients with tipical angina ref(3rred to the catheterization laboratory or once defined as MIaccording WHO critiel with LVEF30.50 (age 65~78, 73 tL 4 Mean+SD), and 26 hea1thy subjectswithoot history of smoking,diabetes and hypercholesterolemia which had been known as the riskfactors of endothelia function. Doppler ultrasonograPhy technical was adopted to assessment thebrachial endothelium -depended relaxation and blood flow increase during reactive hyperemia.Endothlin-l (ET --l) and von WllbI'and factor (vWF) were also as notations of endotheliumfunction. Distensibility coeffcient, colnpliance coeffcient (DC, CC) and resistance(R) of brachialartery were calculated by the formulation. A non-invasive pulse-wave-velocity (PWV) Dopplerultrasound technique for the assessmel1t of aortic distensibility was persuaded also.21 patients of CHF took Losantar 50 mg. perday after the day of the first ultrasonicexamination was done. l5 CHF patie11ts competed the trea1ment which 1asted fOr l2 weeks. Allthe examination repeated after l2 wee:ks.RcsuIs1. Endothelium-dependent relaxation (D%) (reactive hyperemia -induced) which caused byflow --stimulate increase in NO activity of brachial artel'y was significantly decreased in CHF(4.65 i 5.25%) compared with heaIthy subjects (l2.0I i 4.04%, P<0.0l) and CAD(7.74 i 3. l5%,P<0.0l ). Blood flow increasing of brachial artery (Q%) in CHF(88.32 l 56(ll% ) alsosignificantly decreased comparing with healthy subjects(246.34 l 88.90 %, P<0.0l ) and CAD(l55.l6 t 86.4 %, P<0.0l ). Four of CHF patients indici1ted brachial diameter decreased duringreactive hyperemia. D%. Q% in CA;D was decreased cornpared with healthy subjects but didn'tdecrease as low as CHF. Endothe l ium - in dep endent re l axati on (Dn %) (N TG induc ed) and theBlood flow increased (Qn%) of brachial artery conserved in CHF and did not differ significantlybetween CAD and CHF.2. Plasma endothelin-l was elevated in CHF (60.94ll2.28 pg/ml) compared with healthycontrols (46.9ltl4.42 pg/ml, P <0. 0l) and CAD (46.9lt14.42 Pg/inl, P <0. 0l ). vWF was alsoelevated in CHF (l79.36l43.77 %) and CAD (l68.69l46.92 %) compared with healthy controls(l32.0t37.47, P < 0. 0 I), but there was no statistic significant between CHF and CAD.3. The DC and CC of brachial artery in CHF was lower than healthy subjects and CAD in basicstatus. Study also showed that the aortic PWV measured by Doppler ultrasound technique washigher in CHF than healthy subjects and CAD (P<0.01 fOr both), indicated that large arterydistensibility and compliance were injured in CHF.'4. l5 cases of patients with CHF c()mpleted the treatment of Loswtan lasted for l2 weeks, theLVEF of them evaluated from 44% to 52%(P<0.0l ). D% and Q% also increased comparing to thevalue before the treatment of Losartan, (P<0.0l,respectly ). Plasma ET- l was lower than beforetreated, ET-l decreased significantl...
|
PDF Full Text Request