Document Detail

Dual renin-angiotensin system blockade for patients with prosthesis-patient mismatch.
MedLine Citation:
PMID:  21095333     Owner:  NLM     Status:  MEDLINE    
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.
Umberto Benedetto; Giovanni Melina; Simone Refice; Roberta di Bartolomeo; Antonino Roscitano; Emiliano Angeloni; Riccardo Sinatra
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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.
Department of Cardiac Surgery, II School of Medicine, University of Rome La Sapienza, Policlinico S. Andrea, Rome, Italy.
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MeSH Terms
Adrenergic beta-1 Receptor Antagonists / administration & dosage,  therapeutic use*
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
Follow-Up Studies
Heart Valve Prosthesis / adverse effects*
Heart Ventricles / physiopathology,  ultrasonography
Hypertrophy, Left Ventricular / diagnosis,  drug therapy*,  etiology
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
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

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