Evaluation of Enalapril Losartan Treatment with Cardiopulmonary Exercise Test in Patients with Left Ventricular Systolic Dysfunction

OBJECTIVE
The aim of this study was to evaluate enalapril+losartan treatment with cardiopulmonary exercise test (CPET) in patients with left ventricular systolic dysfunction.
METHODS
The patients with left ventricular systolic dysfunction (ejection fraction: ?40%) were included in this study. A totall of 30 subjects were studied; 20 patients (18 male, 2 female; mean age:62±6) as the study group and 10 patients (8 male, 2 female; mean age:59±11) as control group. All study patients were using enalapril 20 mg/day initially. Fifty mg losartan was added to the study group. CPET was performed to the study group before and 6-8 weeks after beginning of the losartan therapy. To the control group CPET was performed twice; at the begining and 6-8 weeks later without any change in the treatment protocol.
RESULTS
In the study group the average exercise times were 361±192 sec. and 454±205 sec., before and after the study, respectively (p=0,001); peak VO2 values were 1209±366 ml/min. and 1284±398 ml/min.; anaerobic treshold VO2 values were 788±187 ml/min. and 855±217 ml/min before and after study respectively (p=0,01). Peak heart rates were 141±28 /min and 143±22 /min (p=0,35); peak VO2/HR values were 9,02±3,1 ml/min and 9,3±3,0 ml/min (p=0,4) before and after study, respectively. On the other hand, in the control group average exercise times were 556±250 sec 528±251 sec (p=0,8), peak VO2 values were 1502±537 ml/min and 1450±501 ml/min (p=0,2); and anaerobic treshold VO2 values were 1005±338 ml/min and 975±319 ml/min (p=0,7) before and after study, respectively. At the highest comparable exercise stage for both tests in the study group VE/VO2 ratio declined from 35,13±6,2 to 32,44±5,6 (p=0,07). VE values from 37,5±10,9 lt to 33,99±10,14 lt (p=0,02); and heart rate from 140±27/min to 132±21 /min (p=0,02). There was no statistical difference in these parameters in the control group.
CONCLUSION
Addition of losartan to the standart therapy in patients with left ventricular systolic dysfunction; improves exercise capacity and causes lower heart rate and ventilation requirements for the same exercise stage.