Design and rationale for a comparison study of Olmesartan and Valsartan On myocardial metabolism In patients with Dilated cardiomyopathy (OVOID) trial: study protocol for a randomized controlled trial

Abstract

Background Dilated cardiomyopathy (DCMP) is characterized by ventricular chamber enlargement and systolic dysfunction which may cause heart failure. Patients with DCMP have overactivation of the renin-angiotensin-aldosterone systems, which can also adversely affect myocardial metabolism in heart failure. The impairment of myocardial metabolism can contribute to the progression of left ventricular remodeling and contractile dysfunction in heart failure. Although angiotensin II receptor blockers (ARBs) have been used to treat patients with DCMP, there has been no direct comparison of the efficacy of these agents. The objective of this study is to compare the effects of olmesartan and valsartan on myocardial metabolism in patients with DCMP. Methods/design The OVOID study (a comparison study of Olmesartan and Valsartan On myocardial metabolism In patients with Dilated cardiomyopathy) is designed as a non-blinded, open-label, parallel-group, prospective, randomized, controlled, multicenter clinical trial. A total of 40 DCMP patients aged between 20 and 85 years will be randomly allocated into the olmesartan or the valsartan group. 18F-fluoro-2-deoxyglucose (FDG) cardiac positron emission tomography (PET) will be performed at baseline and six months after receiving the study agent. The primary endpoint is myocardial glucose consumption per square meter, measured using 18F-FDG PET 6 months after receiving the study agent. Discussion The purpose of this trial is to compare the efficacy between olmesartan and valsartan in improving myocardial metabolism in DCMP patients. This will be the first randomized comparative study investigating the differential effects of ARBs on heart failure. Trial registration ClinicalTrials.govNCT04174456. Registered on 18 November 2019

Integrated genomic analysis defines molecular subgroups in dilated cardiomyopathy and identifies novel biomarkers based on machine learning methods

“…BCAAs can be regarded as one of the most important nutritional supplements and are the most characteristic energy source for the oxidation and utilization of myocardial amino acids. Although BCAAs accounts for only 2% of myocardial ATP production, it plays an important role in regulating insulin pathway and mammalian rapamycin like target protein (mTOR) signaling pathway ( Jo et al, 2022 ). In addition, BCAAs can continuously activate mTOR signal and damage insulin signal transduction through insulin receptor substrate, and abnormal BCAAs metabolism can cause the accumulation of BCAAs metabolites and eventually lead to insulin resistance ( Cuomo et al, 2022 ).…”

Integrated genomic analysis defines molecular subgroups in dilated cardiomyopathy and identifies novel biomarkers based on machine learning methods

“…BCAAs can be regarded as one of the most important nutritional supplements and are the most characteristic energy source for the oxidation and utilization of myocardial amino acids. Although BCAAs accounts for only 2% of myocardial ATP production, it plays an important role in regulating insulin pathway and mammalian rapamycin like target protein (mTOR) signaling pathway [34]. In addition, BCAAs can continuously activate mTOR signal and damage insulin signal transduction through insulin receptor substrate, and abnormal BCAAs metabolism can cause the accumulation of BCAAs metabolites and eventually lead to insulin resistance [35].…”

The Clinical Evolution of Diffuse Myocardial Fibrosis in Patients With Arterial Hypertension and Heart Failure With Mildly Reduced Ejection Fraction Treated by Olmesartan or Sacubitril / Valsartan

“…При этом, как оказывается, ингибиторы ангио тензинпревращающего фермента, блокаторы рецепторов ангиотензина II, антагонисты альдостерона, статины оказывают антифибротические эффекты [12][13][14]. Ранее олмесартан вместе со статином показал в животной модели аддитивные эффекты комбинированной блокады рецептора АТ1 и ГМГ-КоА-редуктазы на ремоделирование левого желудочка у крыс, перенесших инфаркт [15], и его сравнение с сакубитрилом / валсартаном в разных клинических сценариях поддерживается стабильным интересом исследователей [16][17][18][19].…”

“…[18]. При этом исследователи стремятся сравнивать его прежде всего с АРНИ[16][17][18][19].В настоящем исследовании Олме не превзошел АРНИ во влиянии на регресс диффузного ФМ.…”

“…[18]. При этом исследователи стремятся сравнивать его прежде всего с АРНИ[16][17][18][19].В настоящем исследовании Олме не превзошел АРНИ во влиянии на регресс диффузного ФМ. Скорее наоборот, промежуточные оценки продольной деформации ЛЖ показывали через 3 и 6 мес сходную динамику GLS LV в группах Олме и АРНИ, но через 12 мес наблюдения GLS LV был статистически значимо ниже (т. е. по модулю лучше) в группе АРНИ.…”