Document Detail


Dual renin-angiotensin system blockade for patients with prosthesis-patient mismatch.
MedLine Citation:
PMID:  21095333     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with prosthesis-patient mismatch (PPM) continue to show some degrees of left ventricular hypertrophy after aortic valve replacement for aortic stenosis. The renin-angiotensin system plays a major role in promoting and sustaining hypertrophy. In a controlled, randomized study, we tested the hypothesis that the combination of angiotensin-converting enzyme inhibitors (ACEi) plus angiotensin II receptor blocker (ARB) can be more effective in decreasing hypertrophy than a largely employed association such as ACEi plus ß-blockers in PPM patients.
METHODS: We enrolled a total of 72 patients with aortic valve replacement and evidence of PPM (effective orifice area <0.85 cm(2)/m(2)) at postoperative echocardiography. At discharge, they were randomly assigned to ramipril plus candesartan (n = 36) or ramipril plus metoprolol (n = 36).
RESULTS: At baseline, age, 24-hour blood pressure, left ventricular measurements, and transprosthetic gradients were similar between the two groups. After 12 months, the extent of 24-hour systolic and diastolic blood pressure decrease was similar between the two groups (-13.3% and 16.3% versus -12.3% and 15.8%, respectively; p = 0.7 and 0.8, respectively). Left ventricular mass index significantly decreased in both groups (ACEi plus ARB 165 ± 19 g/m(2) to 117 ± 17 g/m(2); p < 0.0001; ACEi plus β-blockers 161 ± 15 g/m(2) to 128 ± 20 g/m(2); p < 0.0001). However, patients receiving ACEi plus ARB had a higher decrease of left ventricular mass (-46 ± 15 g/m(2) versus -35 ± 12 g/m(2); p = 0.001) and a lower rate of residual left ventricular hypertrophy (22% versus 47%; p = 0.04).
CONCLUSIONS: This study shows that in patients with PPM, the association ACEi and ARB has a greater antiremodeling effect compared with ACEi and β-blockers, and is independent of blood pressure.
Authors:
Umberto Benedetto; Giovanni Melina; Simone Refice; Roberta di Bartolomeo; Antonino Roscitano; Emiliano Angeloni; Riccardo Sinatra
Related Documents :
6715543 - The genesis of the third and fourth heart sounds. a pressure-flow study in dogs.
3376843 - Clinical and hemodynamic characteristics of patients with inducible pulsus alternans.
19444363 - Correlation of maximum urethral closure pressure with valsalva leak point pressure usin...
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1899-903; discussion 1903     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiac Surgery, II School of Medicine, University of Rome La Sapienza, Policlinico S. Andrea, Rome, Italy. u2benedetto@libero.it
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-1 Receptor Antagonists / administration & dosage,  therapeutic use*
Aged
Angiotensin II Type 1 Receptor Blockers / administration & dosage,  therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / administration & dosage,  therapeutic use*
Aortic Valve Stenosis / diagnosis,  surgery*
Benzimidazoles / administration & dosage,  therapeutic use
Blood Pressure / drug effects
Dose-Response Relationship, Drug
Drug Therapy, Combination
Echocardiography
Female
Follow-Up Studies
Heart Valve Prosthesis / adverse effects*
Heart Ventricles / physiopathology,  ultrasonography
Humans
Hypertrophy, Left Ventricular / diagnosis,  drug therapy*,  etiology
Male
Metoprolol / administration & dosage,  therapeutic use
Prosthesis Design
Prosthesis Failure
Ramipril / administration & dosage,  therapeutic use
Renin-Angiotensin System / drug effects*
Retrospective Studies
Tetrazoles / administration & dosage,  therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-1 Receptor Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Benzimidazoles; 0/Tetrazoles; 37350-58-6/Metoprolol; 87333-19-5/Ramipril; S8Q36MD2XX/candesartan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Altered oxidative stress responses and increased type I collagen expression in bicuspid aortic valve...
Next Document:  Predictors of mitral valve repair: clinical and surgeon factors.