| Dual renin-angiotensin system blockade for patients with prosthesis-patient mismatch. | |
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MedLine Citation:
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PMID: 21095333 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Umberto Benedetto; Giovanni Melina; Simone Refice; Roberta di Bartolomeo; Antonino Roscitano; Emiliano Angeloni; Riccardo Sinatra |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 90 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-24 Completed Date: 2011-01-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1899-903; discussion 1903 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiac Surgery, II School of Medicine, University of Rome La Sapienza, Policlinico S. Andrea, Rome, Italy. u2benedetto@libero.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-1 Receptor Antagonists
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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:
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0/Adrenergic beta-1 Receptor Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Benzimidazoles; 0/Tetrazoles; 139481-59-7/candesartan; 37350-58-6/Metoprolol; 87333-19-5/Ramipril |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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