title: Angiotensin-converting enzyme polymorphisms and their potential impact on left ventricular myocardial geometry after aortic valve surgery.
abstract: OBJECTIVE
  Genetic variants of the angiotensin-converting enzyme (ACE) cascade may influence left ventricular myocardial mass (LVMM) regression after aortic valve surgery. Postoperative long-term changes in LV indices were investigated in patients with asymptomatic aortic regurgitation (AR) and symptomatic aortic stenosis (AS) and related to alleles of ACE polymorphisms.
  
  
  METHODS
  A total of 96 patients was included in the study, 21 with class IIa AR (22%) and 75 with class I AS (78%) recommendations for surgery. Patients were evaluated for demographic risk factors and underwent a thorough clinical examination including 3-D cardiac imaging by ultrafast-computed tomography. Genomic DNA was isolated for genotyping.
  
  
  RESULTS
  AR patients were younger (55.8 +/- 8.9 versus 64 +/- 9.1 years, p = 0.0014), had a larger body surface area (1.92 +/- 0.21 versus 1.82 +/- 0.19 m2, p = 0.039), and were more likely to be asymptomatic (myocardial infarction, p = 0.04; syncope, p = 0.0099; thromboembolism, p = 0.03; NYHA class IV, p = 0.04). Postoperatively, the reduction in absolute LVMM (from 297.1 +/- 52.6 to 190.1 +/- 57.1 g versus 214.4 +/- 55.7 to 143.8 +/- 40.0 g; pT = 0.0000001) and indexed LVMM (from 156.0 +/- 31.7 to 99.3 +/- 28.4 g/m2 versus 118.7 +/- 28.3 to 79.3 +/- 20.6 g/m; pT = 0.0000001) over time was more significant in AR patients, but never reached normal values. Enforced ACE inhibitor medication resulted in significantly higher postoperative indexed LVMM differences in homozygote DD patients compared to AR patients with II/ID alleles of ACE 16 ins/del polymorphism.
  
  
  CONCLUSIONS
  AR patients showed a statistically significant decrease in absolute/indexed LVMM during follow up, but never achieved LV mass recovery compared to standard values or to values in patients undergoing aortic valve replacement for AS. The benefits of ACE inhibitors were observed among AR patients with homozygote DD alleles of ACE 16 ins/del polymorphism.
authors.affiliation: Division of Cardiovascular Surgery, Justus Liebig University, Giessen, Germany. igor_knezdr@yahoo.de
authors.forename: Igor
authors.initials: I
authors.lastname: Knez
authors.forename: Wilfried
authors.initials: W
authors.lastname: Renner
authors.forename: Robert
authors.initials: R
authors.lastname: Maier
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Rainer
authors.initials: R
authors.lastname: Rienmüller
authors.forename: Martin
authors.initials: M
authors.lastname: Pilsl
authors.forename: Olaf
authors.initials: O
authors.lastname: Stanger
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Mircic
authors.forename: Drago
authors.initials: D
authors.lastname: Dacar
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Szalay
authors.forename: Ivo
authors.initials: I
authors.lastname: Martinovic
authors.forename: Paul R
authors.initials: PR
authors.lastname: Vogt
authors.forename: Bruno
authors.initials: B
authors.lastname: Rigler
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000235:genetics* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000235:genetics* / Q000601:surgery; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D005819:Genetic Markers; D014644:Genetic Variation; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000235:genetics; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000235:genetics* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic; D011184:Postoperative Period; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D005819:Genetic Markers; D007703:Peptidyl-Dipeptidase A