title: Effect of Renin-Angiotensin Blockers on Left Ventricular Remodeling in Severe Aortic Stenosis.
abstract: Studies have shown that medical therapy with renin-angiotensin blockers (RABs) may benefit patients with aortic stenosis (AS). However, its use and efficacy remains controversial, including in patients with low flow (LF) with preserved left ventricular ejection fraction (LVEF). We examined the effects of RAB use on LV remodeling in patients with severe AS with preserved LVEF, analyzing the differential effects in patients with LF compared with normal flow (NF). This is a retrospective study of 428 consecutive subjects from 2005 to 2014 with echocardiographic diagnosis of severe AS and preserved LVEF. Clinical and echocardiographic parameters were systematically collected and analyzed. Two hundred forty-two (57%) patients had LF. Sixty-four LF patients (26%) were treated with RAB. Patients on RAB treatment had a higher incidence of hyperlipidemia (69% vs 44%) and diabetes mellitus (53% vs 34%). Severity of AS in terms of valve area, transvalvular mean pressure gradient, and aortic valve resistance were similar between both groups as was the degree of LV diastolic function. The RAB group demonstrated significantly lower LV mass index with a correspondingly lower incidence of concentric LV hypertrophy. Regardless of the duration of RAB therapy, patients had increased odds of having a preserved LV mass index compared with those without RAB therapy. In conclusion, RAB therapy may be associated with less LV pathological remodeling and have a role in delaying patients from developing cardiovascular complications of AS.
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Serene Si-Ning
authors.initials: SS
authors.lastname: Goh
authors.affiliation: Department of Medicine, University Medicine Cluster, National University Health System, Singapore, Singapore.
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Sia
authors.affiliation: Department of Medicine, University Medicine Cluster, National University Health System, Singapore, Singapore.
authors.forename: Nicholas Jinghao
authors.initials: NJ
authors.lastname: Ngiam
authors.affiliation: Department of Medicine, University Medicine Cluster, National University Health System, Singapore, Singapore.
authors.forename: Benjamin Yong-Qiang
authors.initials: BY
authors.lastname: Tan
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Poay Sian
authors.initials: PS
authors.lastname: Lee
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
authors.forename: Edgar Lik-Wui
authors.initials: EL
authors.lastname: Tay
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
authors.forename: William Kok-Fai
authors.initials: WK
authors.lastname: Kong
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
authors.forename: Tiong Cheng
authors.initials: TC
authors.lastname: Yeo
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore. Electronic address: kian_keong_poh@nuhs.edu.sg.
authors.forename: Kian-Keong
authors.initials: KK
authors.lastname: Poh
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000809:Angiotensins / Q000037:antagonists & inhibitors; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000187:drug effects*; D000092502:Renin Inhibitors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000809:Angiotensins; D000092502:Renin Inhibitors