کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5927211 | 1167694 | 2014 | 9 صفحه PDF | دانلود رایگان |
BackgroundIn 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.MethodsForty-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.ResultsCompared with placebo, systolic blood pressure and systemic arterial compliance significantly changed at day 3 (â14 ± 11 vs â5 ± 13 mm Hg, P = .02, and 0.08 ± 0.16 vs â0.05 ± 0.86 mL/m2 per mm Hg, P = .03, respectively). Changes in left ventricular end systolic volume (LVESV) was nonsignificant (â8 ± 9 vs â3 ± 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 (â7.8 ± 2.6 vs â0.5 ± 2.5 mL, P = .04, and â19 ± 7 vs 0.8 ± 6 pmol/L, P = .04, respectively). No episodes of symptomatic hypotension were noted, and other hemodynamic parameters remained unchanged.ConclusionAngiotensin-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.
Journal: American Heart Journal - Volume 167, Issue 2, February 2014, Pages 226-234