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Addition of Valsartan to an Angiotensin-Converting Enzyme Inhibitor Improves Cardiac Sympathetic Nerve Activity and Left Ventricular Function in Patients with Congestive Heart Failure

¹ Second Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan
² Cardiovascular Hospital of Central Japan, Gunma, Japan

We determined whether the addition of the angiotensin-receptor blocker valsartan to an angiotensin-converting enzyme (ACE) inhibitor improves cardiac sympathetic nerve activity and left ventricular function in patients with congestive heart failure (CHF). Methods: Thirty-two patients with CHF (left ventricular ejection fraction [LVEF] < 40%; mean, 33% ± 6%) were treated with an ACE inhibitor and a loop diuretic. Sixteen patients (group A) were randomized to additionally receive valsartan (40–80 mg/d), and the remaining 16 patients (group B) continued their current regimen. Patients were studied before and 6 mo after treatment. The delayed heart-to-mediastinum count ratio (H/M ratio), delayed total defect score (TDS), and washout rate (WR) were determined from ¹²³I-metaiodobenzylguanidine images. The left ventricular end-diastolic volume (LVEDV) and LVEF were determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated. Results: Before treatment, TDS, H/M ratio, WR, LVEDV, LVEF, and NYHA functional class were similar in both groups. After treatment in group A, TDS decreased from 37 ± 8 to 31 ± 9 (P < 0.001), H/M ratio increased from 1.66 ± 0.23 to 1.81 ± 0.23 (P < 0.001), and WR decreased from 47% ± 9% to 39% ± 10% (P < 0.01). In addition, the LVEDV decreased from 193 ± 36 mL to 169 ± 51 mL (P < 0.005), and LVEF increased from 32% ± 7% to 41% ± 13% (P = 0.0005). In group B, these parameters did not change significantly. NYHA functional class improved in both groups (in group A, from 3.3 ± 0.5 to 1.7 ± 0.6 [P < 0.0005]; in group B, from 3.3 ± 0.5 to 2.4 ± 0.6; [P < 0.005]). The improvement was significantly greater in group A than in group B (P < 0.05). Conclusion: The addition of valsartan to an ACE inhibitor improves cardiac sympathetic nerve activity, left ventricular function, and symptoms in patients with CHF.

Key Words: ¹²³I-metaiodobenzylguanidine • heart failure • angiotensin-receptor blocker

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