Key result
Treatment with angiotensin-converting enzyme inhibitors in children with single ventricle physiology reduced ventricular end-diastolic pressure from 13 to 10 mmHg (p=0.002).
Why the study?
Do angiotensin-converting enzyme inhibitors reduce elevated filling pressures in children with single ventricle physiology?
Observational (n=17)
No
Do angiotensin-converting enzyme inhibitors reduce elevated filling pressures in children with single ventricle physiology?
ACE inhibitor therapy may reduce ventricular end-diastolic, pulmonary artery, and mean atrial pressures in children with single ventricle physiology and elevated filling pressures.
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.
No takes yet. Share an insight, caveat, or question.
Yim et al. (2015) conducted an observational in Single ventricle physiology (n=17). Angiotensin-converting enzyme inhibitors vs. Baseline (pre-treatment) was evaluated on End-diastolic pressure (p=0.002). Treatment with angiotensin-converting enzyme inhibitors in children with single ventricle physiology reduced ventricular end-diastolic pressure from 13 to 10 mmHg (p=0.002).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: