Key result
High-dose valsartan boosts regional wall motion recovery ~65% over low-dose therapy post-PCI in STEMI.
Why the study?
The study aimed to evaluate mid-term changes in cardiac function by transthoracic echocardiography in STEMI patients undergoing primary PCI according to valsartan dose.
Does high dose valsartan improve mid-term cardiac function by TTE compared to low dose valsartan in patients with STEMI following primary PCI?
RCT (n=78)
Randomly assigned with concealed allocation
No
Does high dose valsartan improve mid-term cardiac function by TTE compared to low dose valsartan in patients with STEMI following primary PCI?
High-dose valsartan may be more effective than low-dose valsartan in improving regional wall motion in injured myocardium after primary PCI for STEMI.
High-dose valsartan was associated with greater wall motion recovery post-STEMI; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: The aim of this study was to evaluate the mid-term changes in cardiac function by transthoracic echocardiogram (TTE) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) according to valsartan dose. METHODS: Between April 2006 and February 2009, 78 subjects (mean age: 57 ± 12 years, M : F = 74 : 4) with STEMI who underwent primary PCI were enrolled. Fifty three patients received low dose valsartan (40 or 80 mg) and 25 patients received high dose valsartan (160 or 320 mg). Follow-up TTE was done approximately 2 years later. We evaluated the changes in left ventricular (LV) function between initial and final TTE after primary PCI and compared the changes between low and high dose valsartan group. RESULTS: The mean follow-up TTE duration was 24 ± 8 months. Deceleration time (188.6 ± 56.3 msec vs. 221.5 ± 71.3 msec, p = 0.01), E/e' (12.24 ± 5.2 vs. 10.1 ± 4.9, p = 0.002), ejection fraction (52.7 ± 8% vs. 55.2 ± 8.4%, p < 0.01), and wall motion score index (1.45 ± 0.30 vs. 1.33 ± 0.32, p < 0.01) showed significant changes during the follow-up period. Wall motion improvement in injured myocardial segments was more frequently observed in the high-dose valsartan group compared to the low-dose group [18/25 (72%) vs. 24/53 (43.7%), p = 0.03]. There was no significant difference in the changes in cardiac dimensions and function between the low and high dose valsartan group. CONCLUSION: In patients with STEMI who undergoing primary PCI, high-dose valsartan treatment may be more helpful than low-dose in improving wall motion in the injured myocardium.
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Kim et al. (2010) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=78). High-dose valsartan vs. Low-dose valsartan (40 or 80 mg daily) was evaluated on Wall motion improvement in ≥2 segments of injured myocardium by ≥1 grade (p=0.03). High-dose valsartan significantly increased the proportion of patients with wall motion improvement in injured myocardial segments compared to low-dose valsartan (72.0% vs 43.7%) in STEMI patients after primary PCI.
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