title: Aortic valvular heart disease: Is there a place for angiotensin-converting-enzyme inhibitors?
abstract: Aortic valve disease (AVD) is the most common form of valvular heart disease in the western world. The only proven therapy for severe AVD is open aortic valve replacement, with trans-catheter aortic valve implantation emerging as a promising modality to treat severe aortic stenosis in a selected group of patients. AVD has a long asymptomatic phase with symptoms occurring late in the disease and once symptoms develop, prognosis is poor. There is a growing appreciation that aortic valvular heart disease incorporates a disease process that extends beyond the valve itself leading to an aortic valvular 'heart' disease. The renin-angiotensin system is known to modulate adverse left ventricular remodeling and myocardial fibrosis, which could be caused by increased load caused by the AVD. In this review, the authors explore evidence that suggest that drugs that target the renin-angiotensin system may have a potential therapeutic role in AVD.
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, College of Medicine, Dentistry and Nursing, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: Douglas H J
authors.initials: DH
authors.lastname: Elder
authors.forename: Victoria
authors.initials: V
authors.lastname: McAlpine-Scott
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Choy
authors.forename: Allan D
authors.initials: AD
authors.lastname: Struthers
authors.forename: Chim C
authors.initials: CC
authors.lastname: Lang
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D001021:Aortic Valve / Q000378:metabolism / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000517:prevention & control; D000082882:Bicuspid Aortic Valve Disease; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006330:Heart Defects, Congenital / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D012084:Renin-Angiotensin System / Q000187:drug effects; D020257:Ventricular Remodeling / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents