title: Retrospective analysis of the effect of angiotensin II receptor blocker versus β-blocker on aortic root growth in paediatric patients with Marfan syndrome.
abstract: OBJECTIVE
  Cardiovascular pathology, including aortic root dilation at the level of sinus of Valsalva (SV), is one of the major causes of morbidity in paediatric patients with Marfan syndrome (MFS). β-Blocker (BB) is well established to slow aortic dilation in MFS. Less is known about the effectiveness of angiotensin II receptor blocker (ARB) on aortic dilation in paediatric patients with MFS.
  
  
  METHODS
  215 patients with MFS (9.01 ± 5.7 years) were subject to a standardised diagnostic programme. Aortic root dilation was evaluated and followed up by echocardiography. In 48 cases, BB and ARB effects on aortic root dilation were evaluated. Effect of treatment was measured by comparison of z scores of SV before and after treatment initiation.
  
  
  RESULTS
  Treatment by ARB and BB leads to significant reduction of SV dilation (p<0.05). The deviation of SV enlargement from normal as expressed by the rate of change in z scores was significantly reduced by a mean difference of -0.56 ± 0.71 z scores (p<0.001) under ARB therapy and by a mean difference of -0.35 ± 0.68 z scores (p<0.05) under BB therapy. The prophylactic effect of ARB and BB on aortic root dilation is similar in both groups (p>0.05).
  
  
  CONCLUSIONS
  Both concepts lead to a significant reduction of SV dilation. The effect of ARB and BB is similar. This is the first study concerning the comparison of ARB and BB in previously untreated paediatric patients with MFS. The results of the study show that both treatment strategies are beneficial in paediatric and adolescent patients.
authors.affiliation: Clinic for Paediatric Cardiology, University Heart Centre Hamburg, , Hamburg, Germany.
authors.forename: Goetz C
authors.initials: GC
authors.lastname: Mueller
authors.forename: Lydia
authors.initials: L
authors.lastname: Stierle
authors.forename: Veronika
authors.initials: V
authors.lastname: Stark
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Steiner
authors.forename: Yskert
authors.initials: Y
authors.lastname: von Kodolitsch
authors.forename: Jochen
authors.initials: J
authors.lastname: Weil
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Mir
mesh_terms: D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001018:Aortic Diseases / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008790:Metoprolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D013777:Tetrazoles; D000068756:Valsartan; D008790:Metoprolol; D014633:Valine