title: Safety and efficiency of chronic ACE inhibition in symptomatic heart failure patients with a systemic right ventricle.
abstract: BACKGROUND
  ACE inhibition is an established treatment regimen in patients with congestive heart failure due to left ventricular dysfunction which improves morbidity and mortality. However, little is known about the beneficial effects of ACE inhibition in adult patients after Mustard procedure for transposition of the great arteries with heart failure symptoms. Therefore, we investigated the effects of ACE inhibition in these patients on heart failure symptoms, echocardiographic diameters, NT-proBNP and exercise capacity.
  
  
  METHODS
  In 14 patients (age 25.2 ± 3.5 years), after Mustard procedure for transposition of the great arteries (age at operation 1.1 ± 1.3 years) with heart failure NYHA II (New York Heart Association class), an ACE inhibition was initiated. At baseline and 13.3 ± 4.0 months after treatment with enalapril (10mg twice a day), echocardiography, exercise test and NT-proBNP measurements were performed and compared to an age- and sex-matched control group.
  
  
  RESULTS
  Maximum oxygen uptake and echocardiographic parameters did not change significantly in both groups. However, NT-proBNP showed a significant decrease in the treatment group (242 ± 105 vs. 151 ± 93 ng/l, p=0.004), while in the control group a significant increase (120 ± 89 vs. 173 ± 149 ng/l, p<0.05) was observed. Furthermore, ACE inhibitor treatment did not result in a deterioration of heart failure symptoms or renal function.
  
  
  CONCLUSIONS
  Thus, ACE inhibitor treatment of heart failure symptoms in patients with a systemic right ventricle is safe and reduces NT-proBNP levels significantly as a marker for ventricular overload. Nevertheless, larger scale trials are warranted to show effects on morbidity and mortality in this highly selected patient group.
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. Tutarel.Oktay@MH-Hannover.de
authors.forename: Oktay
authors.initials: O
authors.lastname: Tutarel
authors.forename: Gerd Peter
authors.initials: GP
authors.lastname: Meyer
authors.forename: Harald
authors.initials: H
authors.lastname: Bertram
authors.forename: Armin
authors.initials: A
authors.lastname: Wessel
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schieffer
authors.forename: Mechthild
authors.initials: M
authors.lastname: Westhoff-Bleck
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000601:surgery; D055815:Young Adult
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril