在亚临床高压性心肌病中心脏重塑:VANISH随机临床试验
Christoffer Rasmus Vissing1,2, Anna Axelsson Raja1, Sharlene M Day3
1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
JAMA cardiology
|September 6, 2023
概括
瓦尔萨坦在早期高压心肌病 (HCM) 中没有减缓心脏重塑. 虽然瓦尔萨坦没有显著的影响,但一些患者进展到明显的HCM,突出了对疾病进展因素的进一步研究的需要.
科学领域:
- 心脏病学 心脏病学
- 遗传学 是一个遗传学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 早期的瘤性高性心肌病变 (HCM) 涉及到心脏重塑.
- 基因检测可以识别患亚临床HCM风险的个体.
- 瓦尔萨坦在HCM心脏重塑的管理方面显示出潜力.
研究的目的:
- 评价瓦尔萨坦在亚临床HCM中改变疾病发展的疗效.
- 对于具有亚临床HCM的萨尔科默尔变异载体的短期表型进展的特征.
主要方法:
- 一个多中心,双盲,安慰剂对照试验 (VANISH) 随访2年.
- 包括具有早期表型表现的瘤变异携带者,但没有左心室缩 (LVH).
- 主要结局:心脏重塑参数的复合z分数;次要结局:表型进展标志物.
主要成果:
- 与安慰剂相比,瓦尔萨坦对心脏重塑没有统计显著的影响 (复合z分数变化: -0.01;P=.92).
- 观察到适度的2年表型进展,左心房体积略微增加 (3.5mL/m2;P=.002).
- 9名参与者 (26%) 的左心室壁厚度增加,其中6人 (18%) 进展为明显的HCM. 较高的基线左心房体积指数和心室间隔膜厚度与HCM发展有关.
结论:
- 瓦尔萨坦在这个探索性队列中没有在减缓亚临床HCM进展方面表现出有效性.
- 观察到最小的心脏重塑变化,但很大一部分进展到明显的疾病.
- 基线室间隔膜厚度和左心房体积指数预测疾病过渡,强调需要纵向监测和进一步研究疾病透因素.
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