Effects of losartan on left ventricular hypertrophy and fibrosis in patients with nonobstructive hypertrophic cardiomyopathy.

Abstract

OBJECTIVES:

The aim of this study was to evaluate the effects of losartan on left ventricular (LV) hypertrophy and fibrosis in patients with nonobstructive hypertrophic cardiomyopathy (HCM).

BACKGROUND:

Despite evidence that myocardial hypertrophy and fibrosis are mediated by angiotensin II and are important determinants of morbidity and mortality in patients with HCM, no prior studies have evaluated the effects of angiotensin receptor blockers on LV hypertrophy and fibrosis with cardiac magnetic resonance imaging.

METHODS:

In double-blind fashion, 20 patients (3 women, 17 men; age: 51 ± 13 years) with HCM were randomly assigned to receive placebo (n = 9) or losartan 50 mg twice a day (n = 11) for 1 year. Cardiac magnetic resonance imaging was performed at baseline and 1 year to measure LV mass and extent of fibrosis as assessed by late gadolinium enhancement.

RESULTS:

There was a trend toward a significant difference in the percent change in LV mass (median [interquartile range]: +5% [-4% to +21%] with placebo vs. -5% [-11% to -0.9%] with losartan; p = 0.06). There was a significant difference in the percent change in extent of late gadolinium enhancement, with the placebo group experiencing a larger increase (+31% ± 26% with placebo vs. -23% ± 45% with losartan; p = 0.03).

CONCLUSIONS:

This pilot study suggests attenuation of progression of myocardial hypertrophy and fibrosis with losartan in patients with nonobstructive HCM. Confirmation of these results in a larger trial is required to confirm a place for angiotensin receptor blockers in the management of patients with HCM. (Effect of Losartan in Patients With Nonobstructive Hypertrophic Cardiomyopathy; NCT01150461).

• Authors: Yuichi J Shimada, Jonathan J Passeri, Aaron L Baggish, Caitlin O'Callaghan, Patricia A Lowry, Gia Yannekis, Suhny Abbara, Brian B Ghoshhajra, Richard D Rothman, Carolyn Y Ho, James L Januzzi, Christine E Seidman, Michael A Fifer
• Journal: JACC. Heart failure (JACC Heart Fail) Vol. 1 Issue 6 Pg. 480-7 (Dec 2013) ISSN: 2213-1787 [Electronic] United States
• PMID: 24621999 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Losartan

Topics

• Angiotensin II Type 1 Receptor Blockers (administration & dosage)
• Cardiomyopathy, Hypertrophic (complications)
• Double-Blind Method
• Drug Administration Schedule
• Female
• Fibrosis (drug therapy)
• Humans
• Hypertrophy, Left Ventricular (complications, drug therapy)
• Losartan (administration & dosage)
• Magnetic Resonance Angiography
• Male
• Middle Aged
• Myocardium (pathology)
• Pilot Projects
• Prospective Studies