Short-term hemodynamic effect of angiotensin-converting enzyme inhibition in patients with severe aortic stenosis: A placebo-controlled, randomized study

TY - JOUR

T1 - Short-term hemodynamic effect of angiotensin-converting enzyme inhibition in patients with severe aortic stenosis

T2 - A placebo-controlled, randomized study

AU - Dalsgaard, Morten

AU - Iversen, Kasper

AU - Kjaergaard, Jesper

AU - Grande, Peer

AU - Goetze, Jens Peter

AU - Clemmensen, Peter

AU - Hassager, Christian

N1 - © 2014.

PY - 2014/2

Y1 - 2014/2

N2 - Background In patients with severe aortic stenosis (AS), treatment with angiotensin-converting enzyme inhibitors has previously been considered contraindicated. However, there is a lack of clinical evidence to confirm these potential hemodynamic risks and benefits. Methods Forty-four patients with severe AS (aortic valve area <1 cm2) were randomized to treatment with trandolapril 22 mg daily/placebo (1:1). Right heart catheterization and echocardiography were performed at rest and during exercise at baseline and on day 3. Follow-up was performed before valve replacement or after a maximum of 8 weeks, when exercise echocardiography was repeated. Results Compared with placebo, systolic blood pressure and systemic arterial compliance significantly changed at day 3 (-14 ± 11 vs -5 ± 13 mm Hg, P =.02, and 0.08 ± 0.16 vs -0.05 ± 0.86 mL/m2 per mm Hg, P =.03, respectively). Changes in left ventricular end systolic volume (LVESV) was nonsignificant (-8 ± 9 vs -3 ± 11 mL, P =.17). At a median of 49 days of follow-up, changes in LVESV and N-terminal pro-brain natriuretic peptide were even lower revealing significant differences between the groups (-7.8 ± 2.6 vs -0.5 ± 2.5 mL, P =.04, and -19 ± 7 vs 0.8 ± 6 pmol/L, P =.04, respectively). No episodes of symptomatic hypotension were noted, and other hemodynamic parameters remained unchanged. Conclusion Angiotensin-converting enzyme inhibition in severe AS caused a decrease in LVESV and N-terminal pro-brain natriuretic peptide with other hemodynamic parameters preserved both at rest and during exercise implying hemodynamic improvement with left ventricular unloading.

AB - Background In patients with severe aortic stenosis (AS), treatment with angiotensin-converting enzyme inhibitors has previously been considered contraindicated. However, there is a lack of clinical evidence to confirm these potential hemodynamic risks and benefits. Methods Forty-four patients with severe AS (aortic valve area <1 cm2) were randomized to treatment with trandolapril 22 mg daily/placebo (1:1). Right heart catheterization and echocardiography were performed at rest and during exercise at baseline and on day 3. Follow-up was performed before valve replacement or after a maximum of 8 weeks, when exercise echocardiography was repeated. Results Compared with placebo, systolic blood pressure and systemic arterial compliance significantly changed at day 3 (-14 ± 11 vs -5 ± 13 mm Hg, P =.02, and 0.08 ± 0.16 vs -0.05 ± 0.86 mL/m2 per mm Hg, P =.03, respectively). Changes in left ventricular end systolic volume (LVESV) was nonsignificant (-8 ± 9 vs -3 ± 11 mL, P =.17). At a median of 49 days of follow-up, changes in LVESV and N-terminal pro-brain natriuretic peptide were even lower revealing significant differences between the groups (-7.8 ± 2.6 vs -0.5 ± 2.5 mL, P =.04, and -19 ± 7 vs 0.8 ± 6 pmol/L, P =.04, respectively). No episodes of symptomatic hypotension were noted, and other hemodynamic parameters remained unchanged. Conclusion Angiotensin-converting enzyme inhibition in severe AS caused a decrease in LVESV and N-terminal pro-brain natriuretic peptide with other hemodynamic parameters preserved both at rest and during exercise implying hemodynamic improvement with left ventricular unloading.

KW - Aged

KW - Aged, 80 and over

KW - Angiotensin-Converting Enzyme Inhibitors

KW - Aortic Valve Stenosis

KW - Dose-Response Relationship, Drug

KW - Double-Blind Method

KW - Echocardiography

KW - Exercise Test

KW - Female

KW - Follow-Up Studies

KW - Hemodynamics

KW - Humans

KW - Indoles

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Severity of Illness Index

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.ahj.2013.11.002

DO - 10.1016/j.ahj.2013.11.002

M3 - Journal article

C2 - 24439984

SN - 0002-8703

VL - 167

SP - 226

EP - 234

JO - American Heart Journal

JF - American Heart Journal

IS - 2

ER -