Clinical research
Heart failure
Effects of candesartan on cardiac sympathetic nerve activity in patients with congestive heart failure and preserved left ventricular ejection fraction

https://doi.org/10.1016/j.jacc.2004.11.038Get rights and content
Under an Elsevier user license
open archive

Objectives

We sought to evaluate the effects of angiotensin receptor blocker (ARB) on cardiac sympathetic nerve activity (CSNA) in patients with congestive heart failure (CHF) with a preserved left ventricular ejection fraction (LVEF).

Background

Approximately 50% of patients with CHF have preserved LVEF. It is reported that ARB therapy improves CSNA in CHF patients and reduced LVEF. However, the effect of ARB therapy on CSNA evaluated by iodine-123 meta-iodobenzylguanidine (123I-MIBG) scintigraphy has not been determined in CHF patients with preserved LVEF.

Methods

We selected 50 patients with nonischemic CHF and LVEF >40% who were treated with standard therapy. Twenty-five patients were randomized to also receive candesartan, whereas the remaining 25 patients received placebo. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined by 123I-MIBG scintigraphy before and six months after treatment. The LV end-diastolic volume and LVEF were determined by echocardiography, and the plasma brain natriuretic peptide (BNP) concentration was also measured.

Results

In patients receiving candesartan, 123I-MIBG scintigraphic and echocardiographic parameters were significantly improved after treatment. In contrast, there were no significant changes in these parameters in patients receiving placebo. There was a significant correlation between the changes in 123I-MIBG scintigraphic findings and the percent change in BNP from baseline to six months in patients receiving candesartan (TDS: r = 0.587, p < 0.005; H/M ratio: r = −0.509, p < 0.01; WR: r = 0.602, p < 0.005).

Conclusions

Adding candesartan to standard therapy can improve CSNA and LV performance in CHF patients with preserved LVEF.

Abbreviations and acronyms

ARB
angiotensin receptor blocker
BNP
brain natriuretic peptide
CHF
congestive heart failure
H/M
heart/mediastinum count
LVEDV
left ventricular end-diastolic volume
LVEF
left ventricular ejection fraction
123I-MIBG
iodine-123 meta-iodobenzylguanidine
NYHA
New York Heart Association
TDS
total defect score
WR
washout rate

Cited by (0)