Effect of anti-heart failure therapy on diastolic function in children with single-ventricle circulations.

Abstract

BACKGROUND:

Children with functionally univentricular circulations have chronic volume loading of the systemic ventricle, potentially affecting ventricular function. Medications including angiotensin-converting enzyme inhibitors and β-blockers are used to treat ventricular dysfunction, despite limited evidence of their efficacy in this population.

OBJECTIVE:

To determine the effects of angiotensin-converting enzyme inhibitors on elevated filling pressures in children with single ventricle physiology.

METHODS:

We performed a single-centre, retrospective review of patients with single ventricle physiology who underwent multiple cardiac catheterisations between 1991 and 2013. Study population comprised of patients who commenced or had optimised dosing of angiotensin-converting enzyme inhibitors between assessments in response to high ventricular filling pressures. Patients undergoing interventions influencing loading conditions between assessments were excluded.

RESULTS:

A total of 17 patients were identified, with dominant morphologic right ventricle in eight patients (47.1%). Among them, 11 (64.7%) were pre-Fontan and six (35.3%) were post-Fontan completion. Median inter-assessment interval was 9.4 months (range 7.3-19.1). There was a reduction in end-diastolic pressure from 13 to 10 mmHg (p=0.002), mean pulmonary artery pressure from 16 to 13 mmHg (p=0.049), and mean atrial pressure from 12 to 9 mmHg (p=0.001). There was one cardiac transplant, and there were no patient deaths at median follow-up after 31 months.

CONCLUSIONS:

We observed a reduction in ventricular end-diastolic pressure, pulmonary artery pressure, and mean atrial pressure following treatment with angiotensin-converting enzyme inhibitors in patients with single ventricle physiology. Our study provides insights into the potential impact of anti-heart failure therapy in single ventricle circulations and calls for larger, controlled studies to assess for a therapeutic response.

• Authors: Deane L S Yim, Bryn O Jones, Peta M A Alexander, Yves d'Udekem, Michael M H Cheung
• Journal: Cardiology in the young (Cardiol Young) Vol. 25 Issue 7 Pg. 1293-9 (Oct 2015) ISSN: 1467-1107 [Electronic] England
• PMID: 25739738 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors

Topics

• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Blood Pressure (drug effects)
• Cardiac Catheterization (methods)
• Child
• Child, Preschool
• Female
• Fontan Procedure (methods)
• Heart Failure (drug therapy)
• Heart Ventricles (physiopathology)
• Humans
• Male
• Retrospective Studies
• Ventricular Pressure (drug effects)