PMID- 24439984
OWN - NLM
STAT- MEDLINE
DCOM- 20140318
LR  - 20141120
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 167
IP  - 2
DP  - 2014 Feb
TI  - Short-term hemodynamic effect of angiotensin-converting enzyme inhibition in 
      patients with severe aortic stenosis: a placebo-controlled, randomized study.
PG  - 226-34
LID - S0002-8703(13)00775-8 [pii]
LID - 10.1016/j.ahj.2013.11.002 [doi]
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.
CI  - (c) 2014.
FAU - Dalsgaard, Morten
AU  - Dalsgaard M
AD  - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University 
      Hospital, Copenhagen, Denmark. Electronic address: md@dadlnet.dk.
FAU - Iversen, Kasper
AU  - Iversen K
AD  - Department of Cardiology, Copenhagen University Hospital, Hillerod Hospital, 
      Hillerod, Denmark.
FAU - Kjaergaard, Jesper
AU  - Kjaergaard J
AD  - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University 
      Hospital, Copenhagen, Denmark.
FAU - Grande, Peer
AU  - Grande P
AD  - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University 
      Hospital, Copenhagen, Denmark.
FAU - Goetze, Jens Peter
AU  - Goetze JP
AD  - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University 
      Hospital, Copenhagen, Denmark.
FAU - Clemmensen, Peter
AU  - Clemmensen P
AD  - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University 
      Hospital, Copenhagen, Denmark.
FAU - Hassager, Christian
AU  - Hassager C
AD  - Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University 
      Hospital, Copenhagen, Denmark.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20131109
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Indoles)
RN  - 1T0N3G9CRC (trandolapril)
SB  - IM
CIN - MMW Fortschr Med. 2014 Mar 6;156(4):34. PMID: 24908771
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin-Converting Enzyme Inhibitors/*administration & dosage
MH  - Aortic Valve Stenosis/diagnosis/*drug therapy/physiopathology
MH  - Dose-Response Relationship, Drug
MH  - Double-Blind Method
MH  - Echocardiography
MH  - Exercise Test
MH  - Female
MH  - Follow-Up Studies
MH  - Hemodynamics/*drug effects
MH  - Humans
MH  - Indoles/*administration & dosage
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2014/01/21 06:00
MHDA- 2014/03/19 06:00
CRDT- 2014/01/21 06:00
PHST- 2012/03/31 00:00 [received]
PHST- 2013/11/03 00:00 [accepted]
PHST- 2014/01/21 06:00 [entrez]
PHST- 2014/01/21 06:00 [pubmed]
PHST- 2014/03/19 06:00 [medline]
AID - S0002-8703(13)00775-8 [pii]
AID - 10.1016/j.ahj.2013.11.002 [doi]
PST - ppublish
SO  - Am Heart J. 2014 Feb;167(2):226-34. doi: 10.1016/j.ahj.2013.11.002. Epub 2013 Nov 
      9.