Preliminary Observation On The Effect Of Valsartan On The Endothelial Function In Patients With Acute Coronary Syndromes

Objective The purpose of this study was to investigate the endothelial function in patients with acute coronary syndromes(ACS)and the effect of percutaneous coronary intervention(PCI) therapy on endothelial function, evaluate the effect associated with angiotensin Ⅱ receptor blocker with valsartan on endothelial function in patients undergone PCI.Methods We assessed endothelium-dependent flow-mediated dilation(FMD) and endothelium-independent nitroglycein-mediated dilation(NMD) of brachial artery by high-resolution color Doppler ultrosound. Seventy patients with ACS and eighteen control subjects were enrolled in the study. First, the groups were matched for age, sex and other risk factors, people with hypertension and diabetes were excluded. FMD and NMD of two groups were compared. Second, basline FMD and NMD of all patients with ACS were measured and the correlation between FMD,NMD and clinical factors was analysed. Then, patients with ACS were divided into PCI and medical groups. FMD and NMD for basline and three months later of two groups were compared. Finely, the PCI group was further subdivided into valsartan and non-valsartan groups. FMD and NMD for basline and three months later of two subgroups were compared; meanwhile the clinical event of two subgroups were monitored. Results (1)Compared with healthy controls, ACS patients had lower FMD (7.62±4.78vs10.57±3.72,P=0.021),but equal NMD(20.80±9.53vs19.02±5.99,P=0.369); (2)A significant negative correlation was found between Basline dialameter of brachial artery and FMD(r=-0.270,P=0.024),NMD(r=-0.252, P=0.035), no correlation was found between FMD,NMD and other factors; (3)There was significant decrease in FMD after PCI therapy(7.83±5.54vs4.42±7.64,P= 0.015),but no significant change in NMD(P=0.179); (4)For valsartan group, FMD of basline and three months later was(8.26±5.49),(8.59±5.01), respectively(P=0.978), NMD was(19.75±9.10)on besline and(25.06±8.25) after three months(P=0.112); while of non-valsartan group, FMD of basline and three months later was(7.58±5.63),(2.76±7.93), respectively(P=0.007), NMD was (19.61±9.17) on basline and(21.26±10.62)after three months(P=0.592); (5)In addition, reangina of valsartan and non-valsartan subgroups was 15.79%, 21.88%, respectively (P=0.838).Conclution Endothelial function was impaired in ACS patients; PCI augmented endothelial dysfunction; Angiotensin Ⅱtype 1 receptor blocker with valsartan could prevent PCI-induced endothelial dysfunction and improve the reactive to nitrous oxide, while improve clinical manifestation. The preservation of endothelial function might explain the beneficial clinical effect in patients undergone PCI.