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

Morten Dalsgaard, Kasper Iversen, Jesper Kjaergaard, Peer Grande, Jens Peter Goetze, Peter Clemmensen, Christian Hassager

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    Abstrakt

    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.

    OriginalsprogEngelsk
    Sider (fra-til)226-234
    Antal sider9
    TidsskriftAmerican heart journal
    Vol/bind167
    Udgave nummer2
    DOI
    StatusUdgivet - 1 feb. 2014

    Fingeraftryk Udforsk hvilke forskningsemner 'Short-term hemodynamic effect of angiotensin-converting enzyme inhibition in patients with severe aortic stenosis: A placebo-controlled, randomized study' indeholder.

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