血管新生素受容体阻害と全身右心室を有する成人の運動能力:多センター,ランダム化,プラセボ対照臨床試験
Annie Dore1, Christine Houde, Kwan-Leung Chan
1Department of Medicine, Montreal Heart Institute, Montreal, Canada. annie.dore@icm-mhi.org
Circulation
|October 12, 2005
まとめ
ロサルタンは,全身右心室 (RVs) を有する成人の運動能力を改善したり,NT-proBNPレベルを低下させなかった. これは,レニン-アニオテンシンシステムの最小限の活性化が,RV機能不全における利益の欠如を説明することを示唆しています.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
- クリニック・トライアル 臨床試験
背景:
- レニン-アニオテンシンシステム (RAS) 阻害は,左心室機能不全の患者に有益である.
- RASブロックが全身右心室 (RVs) に与える影響は不明である.
- システミックなRVは,運動能力の低下と心室機能不全と関連しています.
研究 の 目的:
- ロサルタンによる運動能力と神経ホルモンマーカーの効果を,全身性RV患者で評価する.
- 系統的RV病理生理学におけるRASの役割を調査する.
主な方法:
- マルチセンター,ランダム化,ダブルブラインド,プラセボ対照,クロスオーバー試験.
- 系統的なRVを持つ29人の成人患者 (21 TGA-Mustard, 8 cTGA) を研究した.
- 評価されたVO2max,運動期間,N-ターミナルプロ脳ナトリウレチンペプチド (NT-proBNP),およびアンジオテンシンIIレベル.
主要な成果:
- ロサルタンは,プラセボと比較してVO2maxまたは運動期間を有意に改善しませんでした.
- ロサルタンとプラセボのグループでは,NT-proBNP濃度の有意な違いは観察されなかった.
- ロサルタンではアンジオテンシンII濃度の上昇傾向が認められたが,統計的に有意ではない.
結論:
- ロサルタンは,全身性RVsを持つ成人の運動能力を改善したり,NT-proBNPを減少させたりしません.
- 基礎値での最小限のRAS活性化は,ロサルタン効果の欠如を説明する可能性がある.
- 代替的な病理生理学的メカニズムは,全身性RVの進行性心室機能不全の根底にある可能性があります.
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