A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy
A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas cardiomyopathy
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DOI：
10.1016/j.ahj.2006.12.017
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发表时间：
2007-04-01
影响因子：
4.8
通讯作者：
Tavares, Wilson C., Jr.
中科院分区：
文献类型：
--
作者：
Botoni, Fernando A.;Poole-Wilson, Philip A.;Tavares, Wilson C., Jr.
目的本研究的目的是确定慢性查加斯心肌病的肾素血管紧张素系统（RAS）抑制剂和β-受体阻滞剂的安全性和有效性。背景慢性查加斯心肌病在拉丁美洲引起大量的发病率和死亡率。是否RAS抑制剂和β-受体阻滞剂是安全和有益的，一直受到挑战，因为缺乏正式的trials.Methods我们进行了一项双盲，安慰剂对照，随机试验，在42 wiith锥虫克氏感染和心肌病。所有患者均接受依那普利（上调至20 mg BID）和螺内酯（25 mg QD）。随后，患者被随机分配接受安慰剂（n = 20）或卡维地洛上调至25 mg BID（n = 19）。主要终点为RAS抑制后和卡维地洛加用后左室射血分数（LVEF）的变化。次要终点为其他超声心动图参数、Fractionary评分、生活质量（36项健康调查简表）、纽约心脏协会分级的变化。结果RAS抑制的优化是安全的，血流动力学耐受性良好，并与Fracture评分的改善相关（P = .001）和生活质量以及心胸指数的降低（P = 0.002）、脑钠肽水平（P = 0.032）和RANTES（调节活化、正常T表达和分泌）水平（P = 0.001）。左心室射血分数增加2.3%（P = 0.25）;在LVEF
Objective The objective of this study was to determine the safety and efficacy of renin-aniotensin system (RAS) inhibitors and beta-blockers in chronic Chagas cardiomyopathy.Background Chronic Chagaas cardiomyopathy causes substantial morbidity and mortality in Latin America. Whether RAS inhibitors and beta-blockers are safe and beneficial has been challenged because of the lack of formal trials.Methods We conducted a double-blind, placebo-controlled, and randomized trial in 42 wiith trypanosama cruzi infection and cardiomyopathy. All patients received enalapril (up-tiltrated to 20 mg BID) and spironolactone (25 mg QD). Subsequently, the patients weer randomly assigned to receive placebo (n = 20) or carvedilol up-tiltrated to 25 mg BID (n = 19). The primary end points were change in left ventricular ejection fraction (LVEF) after RAS inhibition and that after the addition of carvedilol. The secondary end points were changes in other echocardiographic parameters, Framingham score, quality of life (36-item Short-Form Health Survey), New York Heart Association class. radiographic indices, brain natriuretic peptide levels, and chemokines as well as safety end points.Results Optimization of RAS inhibition was safe, hemodynamically well tolerated, and associated with improvements in Framingham score (P = .001) and quality of life as well as reductions in the cardiothoracic index (P = .002), brain natriuretic peptide level (P = .032), and RANTES (regulated on activation, normal T expressed and secreted) level (P = .001). Left ventricular ejection fraction increased by 2.3% (P = .25); in patients with an LVEF