Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients
Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients
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DOI：
10.1161/01.cir.0000017264.66561.3d
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发表时间：
2002-05-28
期刊：
影响因子：
37.8
通讯作者：
Ubago, JLM
中科院分区：
文献类型：
--
作者：
Díez, J;Querejeta, R;Ubago, JLM
背景-本研究旨在探讨心肌胶原含量是否与原发性高血压患者的心肌硬度有关。方法和结果-本研究在34例高血压性心脏病患者中进行。其中19名患者在接受氯沙坦治疗12个月后也进行了评估。经静脉室间隔肌内膜活检定量胶原体积分数（CVF）。左心室（LV）腔室硬度（K-LV）由多普勒超声心动图测量的早期二尖瓣充盈波的减速时间确定。基线时的组织学分析显示存在2个亚组的患者：8例重度纤维化和26例非重度纤维化。两组高血压患者的CVF和K-LV值均显著高于正常血压者。此外，与非重度纤维化患者相比，重度纤维化患者的CVF和K-LV值显著增加。重度肝纤维化患者（n = 7）治疗后CVF和K-LV明显下降。在非重度纤维化患者（n = 12）中，这些参数在治疗后均无显著变化。CVF与K-LV呈显著正相关（r = 0.415，P < 0.02）。结论：高血压患者心肌胶原含量与左室僵硬度之间存在密切关系。我们的研究结果还表明，氯沙坦诱导严重心肌纤维化消退的能力与高血压患者心肌硬度的降低有关。
Background-This study was designed to investigate whether myocardial collagen content is related to myocardial stiffness in patients with essential hypertension.Methods and Results-The study was performed in 34 patients with hypertensive heart disease. Nineteen of these patients were also evaluated after 12 months of treatment with losartan. Transvenous endomyocardial biopsies of the interventricular septum were performed to quantify collagen volume fraction (CVF). Left ventricular (LV) chamber stiffness (K-LV) was determined from the deceleration time of the early mitral filling wave as measured by Doppler echocardiography. Histological analysis at baseline revealed the presence of 2 subgroups of patients: 8 with severe fibrosis and 26 with nonsevere fibrosis. Values of CVF and K-LV were significantly higher in the 2 subgroups of hypertensives than in normotensives. In addition, compared with patients with nonsevere fibrosis, patients with severe fibrosis exhibited significantly increased values of CVF and K-LV. After treatment, CVF and K-LV decreased significantly in patients with severe fibrosis (n = 7). None of these parameters changed significantly after treatment in patients with nonsevere fibrosis (n = 12). CVF was directly correlated with K-LV (r = 0.415, P < 0.02) in all hypertensives.Conclusions-These findings show a strong association between myocardial collagen content and LV chamber stiffness in patients with essential hypertension. Our results also suggest that the ability of losartan to induce regression of severe myocardial fibrosis is associated with diminution of myocardial stiffness in hypertensive patients.