Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators

BACKGROUND

The renin-angiotensin system plays an important part in the pathogenesis of congestive heart failure (CHF). This study evaluated the effect of an angiotensin II type 1 receptor antagonist on exercise tolerance and symptoms of CHF.

METHODS AND RESULTS

In this multicenter, double-blind, parallel-group study, 844 patients with CHF were randomized to 12 weeks' treatment with placebo (n=211) or candesartan cilexetil 4 mg (n=208), 8 mg (n=212), or 16 mg (n=213) after a 4-week placebo run-in period. Changes in exercise time, Dyspnea Fatigue Index score, NYHA functional class, and cardiothoracic ratio were determined. Candesartan cilexetil produced a dose-related improvement in exercise time. For the intention-to-treat population, the increase produced by candesartan cilexetil 16 mg was significantly greater than that produced by placebo (47.2 versus 30.8 seconds, P=0.0463). All doses of candesartan cilexetil significantly improved the Dyspnea Fatigue Index score relative to placebo. NYHA class improved more frequently in the candesartan cilexetil groups; the differences relative to placebo were not significant. The decrease in cardiothoracic ratio with candesartan 4 to 16 mg was small but statistically significant compared with placebo (all P<0.05). In all candesartan cilexetil groups, plasma renin activity and angiotensin II levels increased from baseline and aldosterone levels decreased in the 8- and 16-mg treatment groups. Candesartan cilexetil was well tolerated at all doses.

CONCLUSIONS

In summary, treatment with candesartan cilexetil demonstrated significant improvements in exercise tolerance, cardiothoracic ratio, and symptoms and signs of CHF and was well tolerated.

The value of computed tomography in the diagnosis of grating scapula

Snapping or grating scapula is a condition of the shoulder girdle in which the patient complains of pain and an audible snapping sound which may be associated with pain. We evaluated the diagnostic value of the computed tomography (CT) scans using the clinical diagnosis of a grating scapula as the gold standard. This retrospective study reports the sensitivity, specificity, likelihood ratio and receiver operator characteristic curve for the CT scans and the kappa value as a measure of the interobserver agreement. None of the parameters validated the examination. We therefore concluded that CT scans are inappropriate for differentiation between a grating scapula and a normally functioning shoulder except in cases where bony abnormalities are present.

A new biscoumarin glucoside ester from Ruta chalepensis cell cultures

The investigation of a plant cell culture of RUTA CHALEPENSIS L. yielded three compounds: isorutarin, rutacridone, and rutarensin, a so far unknown ester of daphnoretin glucoside ("daphnorin"), as well as 3-hydroxy-3-methylglutaric acid.

Antiinflammatory Compounds from Plagiorhegma dubium Cell Culture1

Successive fractionation of a crude methanolic extract of cultured PLAGIORHEGMA DUBIUM cells, followed by assay of the biological activity using cobra venom factor induced paw oedema, led to the detection and isolation of three compounds with antiinflammatory activity. The substances were identified as the protoberberine alkaloid jatrorrhizine and the lignaneglucosides dehydrodiconiferyl-alcohol-4-beta- D-glucoside and its isomer dehydrodiconiferyl-alcohol-gamma-beta- D-glucoside, the latter a compound not previously described in the literature.