Comparative effects of renin-angiotensin-aldosterone system modulators on right heart function and prognosis in patients with severe systolic chronic heart failure
https://doi.org/10.15829/1728-8800-2012-6-50-55
Abstract
Aim. To compare the effects of renin-angiotensin-aldosterone system (RAAS) modulators in patients with severe chronic heart failure (CHF).
Material and methods. In total, 148 patients (57,4±0,4 years), with severe systolic left ventricular (LV) dysfunction (ejection fraction (EF) <40%) were randomized into 4 groups: Group A (n=38), receiving only ACE inhibitors; Group B (n=37), receiving spironolactone (up to 50 mg); Group C (n=37), receiving valsartan (up to 320 mg); and Group D (n=36), receiving aliskiren (up to 300 mg), in addition to ACE inhibitors, diuretics, b-adrenoblockers, and digoxin. The follow-up phase was 37±0,7 months.
Results. There was a significant reduction in one-year mortality (relative risk (RR) reduction by 31,6% and 47,2%), two-year mortality (RR reduction by 38,6% and 50%), and three-year mortality (RR reduction 32% and 40,1%) in patients receiving ACE inhibitors in combination with spironolactone (p<0,05) or aliskiren (p<0,01), compared to Group A. Right heart functional parameters, as well as the levels of brain natriuretic peptide (BNP) and C-reactive protein (CRP) significantly improved after 12 months in Group A, compared to 6 months in Groups B and C, and to 3 months in Group D.
Conclusion. The combination therapy with ACE inhibitors and spironolactone or aliskiren significantly reduced the risk of mortality and hospitalisation, while the combination therapy with valsartan was associated only with reduced hospitalisation risk. Aliskiren therapy was linked to a significant improvement in right heart function, BNP and CRP levels, and a reduced risk of mortality and hospitalisation.
Material and methods. In total, 148 patients (57,4±0,4 years), with severe systolic left ventricular (LV) dysfunction (ejection fraction (EF) <40%) were randomized into 4 groups: Group A (n=38), receiving only ACE inhibitors; Group B (n=37), receiving spironolactone (up to 50 mg); Group C (n=37), receiving valsartan (up to 320 mg); and Group D (n=36), receiving aliskiren (up to 300 mg), in addition to ACE inhibitors, diuretics, b-adrenoblockers, and digoxin. The follow-up phase was 37±0,7 months.
Results. There was a significant reduction in one-year mortality (relative risk (RR) reduction by 31,6% and 47,2%), two-year mortality (RR reduction by 38,6% and 50%), and three-year mortality (RR reduction 32% and 40,1%) in patients receiving ACE inhibitors in combination with spironolactone (p<0,05) or aliskiren (p<0,01), compared to Group A. Right heart functional parameters, as well as the levels of brain natriuretic peptide (BNP) and C-reactive protein (CRP) significantly improved after 12 months in Group A, compared to 6 months in Groups B and C, and to 3 months in Group D.
Conclusion. The combination therapy with ACE inhibitors and spironolactone or aliskiren significantly reduced the risk of mortality and hospitalisation, while the combination therapy with valsartan was associated only with reduced hospitalisation risk. Aliskiren therapy was linked to a significant improvement in right heart function, BNP and CRP levels, and a reduced risk of mortality and hospitalisation.
About the Authors
K. G. Adamyan
Institute of Cardiology, Yerevan
Armenia
Armenia
L. R. Tumasyan
Institute of Cardiology, Yerevan
Armenia
Armenia
A. L. Chilingaryan
Institute of Cardiology, Yerevan
Armenia
Armenia
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Review
For citations:
Adamyan K.G., Tumasyan L.R., Chilingaryan A.L. Comparative effects of renin-angiotensin-aldosterone system modulators on right heart function and prognosis in patients with severe systolic chronic heart failure. Cardiovascular Therapy and Prevention. 2012;11(6):50-55. (In Russ.) https://doi.org/10.15829/1728-8800-2012-6-50-55
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