Effects of losartan treatment on cardiac autonomic control during volume loading in patients with DCM

This study evaluated the effect of angiotensin II receptor blockade on cardiac autonomic control adaptation and urine output in response to acute isotonic volume load in patients with idiopathic dilated cardiomyopathy (DCM) and asymptomatic to mildly symptomatic heart failure. Left ventricular volumes and heart rate variability measurements were assessed at baseline and during intravenous saline load in 14 patients before and after 2 mo of losartan treatment. After losartan treatment, blood pressure values were lower, whereas left ventricular ejection fraction was higher (F = 79, P< 0.001), than before treatment. During saline load, ejection fraction decreased before losartan treatment (F = 5.6, P< 0.05) but did not change after treatment. Urinary volume, unchanged during saline load in untreated patients, increased after losartan (F = 9.38, P< 0.001). Time-domain measurements that represent vagal modulation of heart rate (root-mean-square successive differences and percentage of differences between successive R-R intervals >50 ms) decreased during saline load in untreated patients (F = 3.1, P< 0.05 and F = 6.5, P< 0.01, respectively), but not after losartan. Similarly, a decrease in very low frequency (F = 3.2, P< 0.05), low-frequency (F = 2.9, P< 0.05), and high-frequency power (F = 6.1, P< 0.01) after saline load was observed only in untreated patients. In patients with DCM, losartan treatment improves the cardiac autonomic adaptation and increases urine output in response to volume overload.