Short-term hemodynamic effect of angiotensin-converting enzyme inhibition in patients with severe aortic stenosis: A placebo-controlled, randomized study
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Short-term hemodynamic effect of angiotensin-converting enzyme inhibition in patients with severe aortic stenosis : A placebo-controlled, randomized study. / Dalsgaard, Morten; Iversen, Kasper; Kjaergaard, Jesper; Grande, Peer; Goetze, Jens Peter; Clemmensen, Peter; Hassager, Christian.
I: American Heart Journal, Bind 167, Nr. 2, 02.2014, s. 226-234.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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 cm(2)) 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/m(2) 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 cm(2)) 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/m(2) 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
VL - 167
SP - 226
EP - 234
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 2
ER -
ID: 138173469