Kosuyolu Heart J 2010;13(1)
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The Effect of Valsartanon Heart Rate Variability and Heart Rate Recovery in Patients
with Mild to Moderate Mitral Stenosis

Dr. Hekim Karapınar1, Dr. Özlem Batukan Esen2, Dr. Mustafa Akçakoyun3, Dr. Göksel Açar3,
Dr. Selçuk Pala3, Dr. Ramazan Kargın3, Dr. Hasan Kaya3, Dr. Anıl Avcı3, Dr. Cevat Kırma3,
Dr. Ali Metin Esen3


1 Van Yüksek İhtisas Hastanesi, Kardiyoloji Kliniği, Van

2 İstanbul Üniversitesi Kardiyoloji Enstitüsü, Kardiyoloji Bölümü, İstanbul

3 Kartal Koşuyolu Yüksek İht. Eğt. ve Araş. Hastanesi, Kardiyoloji Bölümü, İstanbul

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<0.002, 76±6 vs. 69±9 mmHg p<0.044, 44±14 vs. 33±12 p< 0.014, respectively), while the exercise time was significantly increased (786±114 vs. 846±95 sn p< 0.044). In Holter analysis neither time nor frequency domain of HRV parameters showed a meaningful change.

Conclusion: In moderate MS, treatment with Valsartan improved the effort capacity, while autonomic function parameters have been defined on the base of HRV and HRR were not significantly different.

Key Words: Heart rate variability, heart rate recovery, mitral stenosis, valsartan

Hafif-Orta Mitral Darlığı Hastalarında Valsartan'ın Kalp Hızı Değişkenliği ve
Kalp Hızı Toparlanması Üzerine Etkisi

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

Dr. Hekim Karapınar1, Dr. Özlem Batukan Esen2, Dr. Mustafa Akçakoyun3, Dr. Göksel Açar3,
Dr. Selçuk Pala3, Dr. Ramazan Kargın3, Dr. Hasan Kaya3, Dr. Anıl Avcı3, Dr. Cevat Kırma3,
Dr. Ali Metin Esen3


1 Van Yüksek İhtisas Hastanesi, Kardiyoloji Kliniği, Van

2 İstanbul Üniversitesi Kardiyoloji Enstitüsü, Kardiyoloji Bölümü, İstanbul

3 Kartal Koşuyolu Yüksek İht. Eğt. ve Araş. Hastanesi, Kardiyoloji Bölümü, İstanbul

ÖZET

Amaç: Atriyal fibrilasyon (AF) mitral darlığı (MD)'nin önemli bir komplikasyonudur. AF gelişiminde otonom sinir sisteminin etkili olduğu, kalp hızı değişkenliği (KHD) ve kalp hızı toparlanması (KHT)'nın otonom sinir sisteminin göstergesi olduğu ve MD hastalarında bozulduğu bildirilmiştir. Çalışmamızda MD hastalarında Valsartan'ın KHD ve KHT üzerine, dolayısıyla otonom sinir sistemi üzerine etkilerini araştırdık.

Yöntem: Hafif-orta MD olan 11 hasta (39±8 yıl, 10 kadın) çalışmaya alındı. Yaş ve cins olarak eşleştirilmiş 16 gönüllü (38±8 yıl, 14 kadın) kontrol gurubu olarak seçildi. Tüm popülasyona transtorasik ekokardiyografi (TTE), semptomla sınırlı egzersiz testi ve 24 saatlik holter incelemesi yapıldı. Hastalar 14 hafta boyunca günde 160 mg Valsartan ile tedavi edildi. Tedavi sonunda TTE, egzersiz testi ve holter incelemesi tekrarlandı. Holter incelemesinde frekans ve zaman ilişkili alan KHD analizi, egzersiz testinde birinci ve üçüncü dakika analizi yapıldı.

Bulgular: Tedavi öncesinde KHT ve KHD parametreleri bakımından hasta gurubu ile kontrol gurubu arasında önemli bir fark saptanmadı. Valsartan tedavisi sonrasında hastaların sistolik (117±6 karşın 107±4 mmHg p<0.002) ve diyastolik kan basıncı(76±6 karşın 69±9 mmHg p<0.044) değerlerinde ve 1. dakika KHT zamanlarında anlamlı azalma (44±14 karşın 33±12 sn p< 0.014), egzersiz sürelerinde ise anlamlı artış saptandı (786±114 karşın 846±95 sn p< 0.044). Holter EKG analizinde ise KHD'nin hem zaman alan hem de frekans alan parametrelerinde anlamlı değişiklik izlenmedi.

Sonuç: Valsartan kullanımı ile orta MD'li hastalarda egzersiz kapasitesinde artış olmasına rağmen, KHD ve KHT süreleri esas alındığında otonom fonksiyonları gösteren parametrelerde anlamlı bir farklılık saptanmadı.

Anahtar Kelimeler: Kalp hızı değişkenliği, kalp hızı toparlanması, mitral darlığı, valsartan

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<0.002, 76±6 vs. 69±9 mmHg p<0.044, 44±14 vs. 33±12 p< 0.014, respectively), while the exercise time was significantly increased (786±114 vs. 846±95 sn p< 0.044). In Holter analysis neither time nor frequency domain of HRV parameters showed a meaningful change.

Conclusion: In moderate MS, treatment with Valsartan improved the effort capacity, while autonomic function parameters have been defined on the base of HRV and HRR were not significantly different.

Key Words: Heart rate variability, heart rate recovery, mitral stenosis, valsartan

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