Abstract | BACKGROUND: METHODS: Clinically stable rTOF patients with moderate/severe PR were included. A double-blinded, placebo-controlled study of 6 months of ramipril vs placebo was performed. All patients underwent cardiovascular magnetic resonance (CMR), echocardiography, neurohormonal analysis, and objective cardiopulmonary exercise testing at baseline and follow-up. PRIMARY ENDPOINT: The main aim was to detect changes in RV function (primary endpoint CMR-derived RV ejection fraction). RESULTS: Seventy-two patients were enrolled and 64 qualified for the final analysis. There was no difference in the primary endpoint RV ejection fraction. RV long-axis shortening significantly improved in the ramipril group compared to placebo (RV: 2.3 ± 3.8 vs 0.02 ± 2.7 mm; P=0.017) as did LV long-axis shortening (1.9 ± 4.5 vs -0.2 ± 3.7 mm respectively; P=0.030). No clear differences were detected between ramipril and placebo for other measures. In a subgroup of patients with restrictive RV physiology, ramipril resulted in decrease in LV end-systolic volume index and increase in LVEF (-2.4 ± 5.0 vs 2.7 ± 3.6 mL/m(2); P=0.005, 2.5 ± 5.0 vs -1.3 ± 3.5%; P=0.03). Ramipril did not cause adverse events and was well tolerated. CONCLUSIONS:
Ramipril is a well tolerated therapy, improves biventricular function in patients with rTOF and may have a particular role in patients with restrictive RV physiology. Larger, longer-term studies are needed to determine if ACE inhibitors can improve both ventricular remodelling and clinical outcomes. ISRCTN: 97515585).
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Authors | Sonya V Babu-Narayan, Anselm Uebing, Periklis A Davlouros, Michael Kemp, Simon Davidson, Konstantinos Dimopoulos, Stephanie Bayne, Dudley J Pennell, Derek G Gibson, Marcus Flather, Philip J Kilner, Wei Li, Michael A Gatzoulis |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 154
Issue 3
Pg. 299-305
(Feb 09 2012)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 20970202
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2010. Published by Elsevier Ireland Ltd. |
Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
- Ramipril
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Topics |
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Double-Blind Method
- Feasibility Studies
- Humans
- Prospective Studies
- Pulmonary Valve Insufficiency
(complications, physiopathology)
- Ramipril
(therapeutic use)
- Tetralogy of Fallot
(complications, physiopathology, surgery)
- Time Factors
- Ventricular Function
(drug effects)
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