PMID- 20970202
OWN - NLM
STAT- MEDLINE
DCOM- 20130129
LR  - 20141113
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 154
IP  - 3
DP  - 2012 Feb 9
TI  - Randomised trial of ramipril in repaired tetralogy of Fallot and pulmonary 
      regurgitation: the APPROPRIATE study (Ace inhibitors for Potential PRevention Of 
      the deleterious effects of Pulmonary Regurgitation In Adults with repaired 
      TEtralogy of Fallot).
PG  - 299-305
LID - 10.1016/j.ijcard.2010.09.057 [doi]
AB  - BACKGROUND: Optimal treatment for stable repaired tetralogy of Fallot (rTOF) 
      patients with pulmonary regurgitation (PR) and related right ventricular (RV) 
      dilatation, including timing of valve implantation, remains uncertain. We sought 
      to study tolerability of the angiotensin-converting-enzyme (ACE) inhibitor 
      ramipril and its effects on cardiovascular function in these patients. METHODS: 
      Clinically stable rTOF patients with moderate/severe PR were included. A 
      double-blinded, placebo-controlled study of 6 months of ramipril vs placebo was 
      performed. All patients underwent cardiovascular magnetic resonance (CMR), 
      echocardiography, neurohormonal analysis, and objective cardiopulmonary exercise 
      testing at baseline and follow-up. PRIMARY ENDPOINT: The main aim was to detect 
      changes in RV function (primary endpoint CMR-derived RV ejection fraction). 
      RESULTS: Seventy-two patients were enrolled and 64 qualified for the final 
      analysis. There was no difference in the primary endpoint RV ejection fraction. 
      RV long-axis shortening significantly improved in the ramipril group compared to 
      placebo (RV: 2.3 +/- 3.8 vs 0.02 +/- 2.7 mm; P=0.017) as did LV long-axis shortening 
      (1.9 +/- 4.5 vs -0.2 +/- 3.7 mm respectively; P=0.030). No clear differences were 
      detected between ramipril and placebo for other measures. In a subgroup of 
      patients with restrictive RV physiology, ramipril resulted in decrease in LV 
      end-systolic volume index and increase in LVEF (-2.4 +/- 5.0 vs 2.7 +/- 3.6 mL/m(2); 
      P=0.005, 2.5 +/- 5.0 vs -1.3 +/- 3.5%; P=0.03). Ramipril did not cause adverse events 
      and was well tolerated. CONCLUSIONS: Ramipril is a well tolerated therapy, 
      improves biventricular function in patients with rTOF and may have a particular 
      role in patients with restrictive RV physiology. Larger, longer-term studies are 
      needed to determine if ACE inhibitors can improve both ventricular remodelling 
      and clinical outcomes. ( ISRCTN: 97515585).
CI  - Copyright (c) 2010. Published by Elsevier Ireland Ltd.
FAU - Babu-Narayan, Sonya V
AU  - Babu-Narayan SV
AD  - Royal Brompton and Harefield NHS Trust, London, UK.
FAU - Uebing, Anselm
AU  - Uebing A
FAU - Davlouros, Periklis A
AU  - Davlouros PA
FAU - Kemp, Michael
AU  - Kemp M
FAU - Davidson, Simon
AU  - Davidson S
FAU - Dimopoulos, Konstantinos
AU  - Dimopoulos K
FAU - Bayne, Stephanie
AU  - Bayne S
FAU - Pennell, Dudley J
AU  - Pennell DJ
FAU - Gibson, Derek G
AU  - Gibson DG
FAU - Flather, Marcus
AU  - Flather M
FAU - Kilner, Philip J
AU  - Kilner PJ
FAU - Li, Wei
AU  - Li W
FAU - Gatzoulis, Michael A
AU  - Gatzoulis MA
LA  - eng
SI  - ISRCTN/ISRCTN97515585
GR  - PG/02/027/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20101022
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - L35JN3I7SJ (Ramipril)
SB  - IM
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Double-Blind Method
MH  - Feasibility Studies
MH  - Humans
MH  - Prospective Studies
MH  - Pulmonary Valve Insufficiency/*complications/physiopathology
MH  - Ramipril/*therapeutic use
MH  - Tetralogy of Fallot/*complications/physiopathology/surgery
MH  - Time Factors
MH  - Ventricular Function/*drug effects
EDAT- 2010/10/26 06:00
MHDA- 2013/01/30 06:00
CRDT- 2010/10/26 06:00
PHST- 2010/06/20 00:00 [received]
PHST- 2010/09/25 00:00 [accepted]
PHST- 2010/10/26 06:00 [entrez]
PHST- 2010/10/26 06:00 [pubmed]
PHST- 2013/01/30 06:00 [medline]
AID - S0167-5273(10)00772-2 [pii]
AID - 10.1016/j.ijcard.2010.09.057 [doi]
PST - ppublish
SO  - Int J Cardiol. 2012 Feb 9;154(3):299-305. doi: 10.1016/j.ijcard.2010.09.057. Epub 
      2010 Oct 22.