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The Effect of Valsartanon Heart Rate Variability and Heart Rate Recovery in Patients With Mild to Moderate Mitral Stenosis

Year 2010, Volume: 13 Issue: 1, 11 - 15, 01.01.2009

Hekim Karap›nar Özlem Batukan Esen Mustafa Akçakoyun Göksel Açar Selçuk Pala Ramazan Kargın Hasan Kaya An›l Avcı Cevat K›rma Ali Metin Esen

Abstract

Summary: Atrial fibrillation (AF) is known to be one of the most important complications of mitral stenosis (MS). It has been reported that autonomic nervous system (ANS) had an effect on AF development, heart rate variability (HRV) and heart rate recovery (HRR) were under the control of ANS, and their disorders were present in MS. We studied the effect of Valsartan on HRV and HRT, and thus its effect on ANS. Methods: Eleven patients (39±8 years, 10 females) with mild to moderate MS were included in the study. Sixteen volunteers (38±8 years, 14 females) matched for age and sex were selected for control group. All subjects underwent transthoracic echocardiography (TTE), symptom-limited treadmill test and 24 hour Holter monitorization. The patients were administered 160 mg of Valsartan daily for 14 weeks. TTE, treadmill test and Holter monitorization were repeated at the end of treatment period. In Holter monitorization, the time and frequency domain analysis of HRV and in exercise test, HRR at first and third minutes (HRR1 and HRR3) were examined. Results: Before Valsartan treatment, no significant difference was found in HRR and HRV parameters between the two groups. Systolic and diastolic blood pressure, and also HRR1values were significantly decreased after treatment of Valsartan (117±6 vs. 107±4 mmHg p

Keywords

Heart rate variability heart rate recovery mitral stenosis valsartan

References

  • Healey JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005;45:1832–9.
  • MacFadyen RJ,Barr CS, Struthers AD. Aldosterone blockade reduces vascular collagen turnover, improves heart rate variability and reduces early morning rise in heart rate in heart failure patients. Cardiovasc Res 1997;35:30-4.
  • Kontopoulos AG,Athyros VG, Didangelos TP et al. Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic neuropathy. Diabetes Care 1997;20:355-61.
  • Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Heart rate variability, standards of measurement, physiogical interpretation and clinical use. Circulation 1996;93:1043–1065.
  • Ozdemir O, Soylu M, Demir AD, et al. Increased sympathetic nervous system activity as a cause of exercise-induced ventricular tachycardia in patients with normal coronary arteries. Tex Heart Inst J 2003;30:100–104.
  • Demir AD, Soylu M, Balbay Y, Ozdemir O, Korkmaz S. Assessment of autonomic function in subjects with early repolarization. Am J Cardiol 2002;89:990–992.
  • Karas M, Lacourciere Y, LeBlanc AR et al. Effect of the renin-angiotensin system or calcium channel blockade on the circadian variation of heart rate variability, blood pressure and circulating catecholamines in hypertensive patients. J Hypertens 2005;23:1251-60.
  • Yee KM, Pringle SD, Struthers AD. Circadian variation in the effects of aldosterone blockade on heart rate variability and QT dispersion in congestive heart failure. J Am Coll Cardiol 2001;37:1800-1807.
  • Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart Rate Recovery and Treadmill Exercise Score as Predictors of Mortality in Patients Referred for Exercise ECG. JAMA 2000;284:1392-1398.
  • Sipahi I, Tekin G, Yigit Z, Guzelsoy D, Guven O. Effect of quinapril on the attenuated heart rate recovery of type 2 diabetic subjects without known coronary artery disease. Clin Cardiol. 2004;27(8):480-4.
  • Ashino K, Gotoh E, Sumita S, Moriya A, Ishii M. Percutaneous transluminal mitral valvuloplasty normalizes baroreflex sensitivity and sympathetic activity in patients with mitral stenosis. Circulation 1997;96:3443-9.
  • Yuasa T, Takata S, Terasaki T, et al. Percutaneous transluminal mitral valvuloplasty improves cardiopulmonary baroreflex sensitivity in patients with mitral stenosis. Auton Neurosci 2001;94:117-24.
  • Karap›nar H, Esen ÖB, Kaya Z, Karavelio¤lu Y, Emiro¤lu MY, K›z›l›rmak F ve ark. Valsartan’›n mitral darl›¤›nda eforla artan pulmoner arter bas›nc› üzerine etkisi. TKD 24. Ulusal kongresi S-047 Türk Kardiyol Dern Arfl 2008, Suppl 2, 27
  • Gottdiener JS et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004;17:1086-1119.
  • Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiogical interpretation and clinical use. Circulation 1996;93:1043-65.
  • Ozdemir O, Alyan O, Soylu M, Metin F, Kacmaz F, Demir AD ve ark. Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy. Europace 2005;7(3):204-210.
  • Ferguson DW, Berg WJ, Sanders JS. Clinical and haemodynamic correlates of sympathetic nerve activity in normal humans and patients with heart failure: evidence from microneurographic recordings. J Am Coll Cardiol 1990;16:1125-34.
  • Kollai M, Koizumi K, Yamashita H, Brooks CM. Study of cardiac sympathetic and vagal efferent activity during reflex responses produced by stretch of the atria. Brain Res 1978;150:519-32.
  • Davis D, Baily R, Zelis R. Abnormalities in systemic norepinephrine kinetics in human congestive heart failure. Am J Physiol 1988;254:760-6.
  • Nakamura M, Kawata Y, Yoshida H, et al. Relationship between plasma atrial and brain natriuretic peptide concentration and haemodynamic parameters during percutaneous transvenous mitral valvulotomy in patients with mitral stenosis. Am Heart J 1992;124:1283-8.
  • Koizumi K, Nishino H, Brooks CM. Centers involved in the autonomic reflex reactions originating from stretching of the atria. Proc Natl Acad Sci U S A 1977;74:2177-81.

Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan'›n Kalp H›z› De¤iflkenli¤i ve Kalp H›z› Toparlanmas› Üzerine Etkisi

Year 2010, Volume: 13 Issue: 1, 11 - 15, 01.01.2009

Hekim Karap›nar Özlem Batukan Esen Mustafa Akçakoyun Göksel Açar Selçuk Pala Ramazan Kargın Hasan Kaya An›l Avcı Cevat K›rma Ali Metin Esen

Abstract

Amaç: Atriyal fibrilasyon (AF) mitral darl›¤› (MD)'nin önemli bir komplikasyonudur. AF gelifliminde otonom sinir sisteminin etkili oldu¤u, kalp h›z› de¤iflkenli¤i (KHD) ve kalp h›z› toparlanmas› (KHT)'n›n otonom sinir sisteminin göstergesi oldu¤u ve MD hastalar›nda bozuldu¤u bildirilmifltir. Çal›flmam›zda MD hastalar›nda Valsartan'›n KHD ve KHT üzerine, dolay›s›yla otonom sinir sistemi üzerine etkilerini araflt›rd›k. Yöntem: Hafif-orta MD olan 11 hasta (39±8 y›l, 10 kad›n) çal›flmaya al›nd›. Yafl ve cins olarak efllefltirilmifl 16 gönüllü (38±8 y›l, 14 kad›n) kontrol gurubu olarak seçildi. Tüm popülasyona transtorasik ekokardiyografi (TTE), semptomla s›n›rl› egzersiz testi ve 24 saatlik holter incelemesi yap›ld›. Hastalar 14 hafta boyunca günde 160 mg Valsartan ile tedavi edildi. Tedavi sonunda TTE, egzersiz testi ve holter incelemesi tekrarland›. Holter incelemesinde frekans ve zaman iliflkili alan KHD analizi, egzersiz testinde birinci ve üçüncü dakika analizi yap›ld›. Bulgular: Tedavi öncesinde KHT ve KHD parametreleri bak›m›ndan hasta gurubu ile kontrol gurubu aras›nda önemli bir fark saptanmad›. Valsartan tedavisi sonras›nda hastalar›n sistolik (117±6 karfl›n 107±4 mmHg p

Keywords

Kalp h›z› de¤iflkenli¤i kalp h›z› toparlanmas› mitral darl›¤› valsartan

References

  • Healey JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005;45:1832–9.
  • MacFadyen RJ,Barr CS, Struthers AD. Aldosterone blockade reduces vascular collagen turnover, improves heart rate variability and reduces early morning rise in heart rate in heart failure patients. Cardiovasc Res 1997;35:30-4.
  • Kontopoulos AG,Athyros VG, Didangelos TP et al. Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic neuropathy. Diabetes Care 1997;20:355-61.
  • Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Heart rate variability, standards of measurement, physiogical interpretation and clinical use. Circulation 1996;93:1043–1065.
  • Ozdemir O, Soylu M, Demir AD, et al. Increased sympathetic nervous system activity as a cause of exercise-induced ventricular tachycardia in patients with normal coronary arteries. Tex Heart Inst J 2003;30:100–104.
  • Demir AD, Soylu M, Balbay Y, Ozdemir O, Korkmaz S. Assessment of autonomic function in subjects with early repolarization. Am J Cardiol 2002;89:990–992.
  • Karas M, Lacourciere Y, LeBlanc AR et al. Effect of the renin-angiotensin system or calcium channel blockade on the circadian variation of heart rate variability, blood pressure and circulating catecholamines in hypertensive patients. J Hypertens 2005;23:1251-60.
  • Yee KM, Pringle SD, Struthers AD. Circadian variation in the effects of aldosterone blockade on heart rate variability and QT dispersion in congestive heart failure. J Am Coll Cardiol 2001;37:1800-1807.
  • Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart Rate Recovery and Treadmill Exercise Score as Predictors of Mortality in Patients Referred for Exercise ECG. JAMA 2000;284:1392-1398.
  • Sipahi I, Tekin G, Yigit Z, Guzelsoy D, Guven O. Effect of quinapril on the attenuated heart rate recovery of type 2 diabetic subjects without known coronary artery disease. Clin Cardiol. 2004;27(8):480-4.
  • Ashino K, Gotoh E, Sumita S, Moriya A, Ishii M. Percutaneous transluminal mitral valvuloplasty normalizes baroreflex sensitivity and sympathetic activity in patients with mitral stenosis. Circulation 1997;96:3443-9.
  • Yuasa T, Takata S, Terasaki T, et al. Percutaneous transluminal mitral valvuloplasty improves cardiopulmonary baroreflex sensitivity in patients with mitral stenosis. Auton Neurosci 2001;94:117-24.
  • Karap›nar H, Esen ÖB, Kaya Z, Karavelio¤lu Y, Emiro¤lu MY, K›z›l›rmak F ve ark. Valsartan’›n mitral darl›¤›nda eforla artan pulmoner arter bas›nc› üzerine etkisi. TKD 24. Ulusal kongresi S-047 Türk Kardiyol Dern Arfl 2008, Suppl 2, 27
  • Gottdiener JS et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004;17:1086-1119.
  • Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiogical interpretation and clinical use. Circulation 1996;93:1043-65.
  • Ozdemir O, Alyan O, Soylu M, Metin F, Kacmaz F, Demir AD ve ark. Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy. Europace 2005;7(3):204-210.
  • Ferguson DW, Berg WJ, Sanders JS. Clinical and haemodynamic correlates of sympathetic nerve activity in normal humans and patients with heart failure: evidence from microneurographic recordings. J Am Coll Cardiol 1990;16:1125-34.
  • Kollai M, Koizumi K, Yamashita H, Brooks CM. Study of cardiac sympathetic and vagal efferent activity during reflex responses produced by stretch of the atria. Brain Res 1978;150:519-32.
  • Davis D, Baily R, Zelis R. Abnormalities in systemic norepinephrine kinetics in human congestive heart failure. Am J Physiol 1988;254:760-6.
  • Nakamura M, Kawata Y, Yoshida H, et al. Relationship between plasma atrial and brain natriuretic peptide concentration and haemodynamic parameters during percutaneous transvenous mitral valvulotomy in patients with mitral stenosis. Am Heart J 1992;124:1283-8.
  • Koizumi K, Nishino H, Brooks CM. Centers involved in the autonomic reflex reactions originating from stretching of the atria. Proc Natl Acad Sci U S A 1977;74:2177-81.
There are 21 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Hekim Karap›nar This is me

Özlem Batukan Esen This is me

Mustafa Akçakoyun This is me

Göksel Açar This is me

Selçuk Pala This is me

Ramazan Kargın This is me

Hasan Kaya This is me

An›l Avcı This is me

Cevat K›rma This is me

Ali Metin Esen This is me

Publication Date January 1, 2009
Published in Issue Year 2010 Volume: 13 Issue: 1

Cite

APA Karap›nar, H. ., Esen, Ö. B. ., Akçakoyun, M. ., Açar, G. ., et al. (2009). Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i ve Kalp H›z› Toparlanmas› Üzerine Etkisi. Koşuyolu Kalp Dergisi, 13(1), 11-15.
AMA Karap›nar H, Esen ÖB, Akçakoyun M, Açar G, Pala S, Kargın R, Kaya H, Avcı A, K›rma C, Esen AM. Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i ve Kalp H›z› Toparlanmas› Üzerine Etkisi. Koşuyolu Kalp Dergisi. January 2009;13(1):11-15.
Chicago Karap›nar, Hekim, Özlem Batukan Esen, Mustafa Akçakoyun, Göksel Açar, Selçuk Pala, Ramazan Kargın, Hasan Kaya, An›l Avcı, Cevat K›rma, and Ali Metin Esen. “Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i Ve Kalp H›z› Toparlanmas› Üzerine Etkisi”. Koşuyolu Kalp Dergisi 13, no. 1 (January 2009): 11-15.
EndNote Karap›nar H, Esen ÖB, Akçakoyun M, Açar G, Pala S, Kargın R, Kaya H, Avcı A, K›rma C, Esen AM (January 1, 2009) Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i ve Kalp H›z› Toparlanmas› Üzerine Etkisi. Koşuyolu Kalp Dergisi 13 1 11–15.
IEEE H. . Karap›nar, “Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i ve Kalp H›z› Toparlanmas› Üzerine Etkisi”, Koşuyolu Kalp Dergisi, vol. 13, no. 1, pp. 11–15, 2009.
ISNAD Karap›nar, Hekim et al. “Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i Ve Kalp H›z› Toparlanmas› Üzerine Etkisi”. Koşuyolu Kalp Dergisi 13/1 (January 2009), 11-15.
JAMA Karap›nar H, Esen ÖB, Akçakoyun M, Açar G, Pala S, Kargın R, Kaya H, Avcı A, K›rma C, Esen AM. Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i ve Kalp H›z› Toparlanmas› Üzerine Etkisi. Koşuyolu Kalp Dergisi. 2009;13:11–15.
MLA Karap›nar, Hekim et al. “Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i Ve Kalp H›z› Toparlanmas› Üzerine Etkisi”. Koşuyolu Kalp Dergisi, vol. 13, no. 1, 2009, pp. 11-15.
Vancouver Karap›nar H, Esen ÖB, Akçakoyun M, Açar G, Pala S, Kargın R, Kaya H, Avcı A, K›rma C, Esen AM. Hafif-Orta Mitral Darl›¤› Hastalar›nda Valsartan’›n Kalp H›z› De¤iflkenli¤i ve Kalp H›z› Toparlanmas› Üzerine Etkisi. Koşuyolu Kalp Dergisi. 2009;13(1):11-5.