Effect of angiotensin receptor blockade on systemic right ventricular function and size: a small, randomized, placebo-controlled study.
BACKGROUND
The effects of angiotensin converting enzyme inhibitor on systemic right ventricular size and function are unknown.


METHODS
Prospective, double blind, randomized, placebo-controlled clinical trial of 1-year therapy with Ramipril in adult patients with DTGA status postatrial baffle procedure. Primary endpoints were change in systemic right ventricular ejection fraction (RVEF) and right ventricular size assessed by magnetic resonance imaging (MRI).


RESULTS
Seventeen patients were enrolled into the study. Mean age at study enrollment was 26.4+/-5.2 years. Mean baseline RVEF was 44+/-6.5%, mean RVEDV was 206.3+/-75.5 ml. Eight patients were randomized to the treatment group and 9 patients were randomized to the placebo group. RVEF did not improve in the Ramipril group from baseline to 1 year (43.8+/-7.1% vs. 40.9+/-13.3%, p=0.52) and remain unchanged in the placebo group (44.3+/-6.3 vs. 46.3+/-9.6%, p=0.42). RVEDV (184.5+/-56.4 ml vs. 179.6+/-66.4 ml, p=0.64) and RVESV (109.5+/-19.4 ml vs. 111.8+/-30.1, p=0.74) remained unchanged in the Ramipril group from baseline to 1 year as well as in the placebo group (228.1+/-89.2 ml vs. 204.5+/-50.4 ml, p=0.42 and 117.5+/-36.9 ml vs. 117.4+/-26.2 ml, p=0.99, respectively).


CONCLUSIONS
One-year treatment with Ramipril does not seem to affect right ventricular function or size in adult patients with systemic right ventricles after a Mustard or Senning procedure.


CONCLUSIONS
17 Adult patients (mean age of 26.4 +/- 5.2 years) with systemic right ventricles were blindly randomized to 1-year treatment with Ramipril placebo. Systemic right ventricular function (RVEF) and size (RVEDV) were assessed by magnetic resonance imaging at baseline and 1 year. RVEF failed to improve in the Ramipril group (43.8+/-7.1% vs. 40.9+/-13.3%, p=0.52) and remain unchanged in the placebo group (44.3+/-6.3 vs. 46.3+/-9.6%, p=0.42). RVEDV remained unchanged in the study group (184.5+/-56.4 ml vs. 179.6+/-66.4 ml, p=0.64 as well as in the placebo group (228.1 +/- 89.2 ml vs. 204.5 +/- 50.4 ml, p = 0.42). One-year treatment with Ramipril does not improve right ventricular function or attenuate remodeling in adult patients with systemic right ventricles.
Therrien
Judith
J
MAUDE Unit, Jewish General Hospital and McGill University Health Center, McGill University, Montreal, Quebec, Canada.
Provost
Yves
Y
Harrison
Jeanine
J
Connelly
Michael
M
Kaemmerer
Harald
H
Webb
Garry D
GD
D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010807:Physical Endurance; D011446:Prospective Studies; D011788:Quality of Life; D017257:Ramipril / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D016278:Ventricular Function, Right / Q000187:drug effects*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril