In an ACM mouse model, Telmisartan preserved contractile function (74.8% EF vs 42.5% for vehicle) but increased arrhythmias and fibrosis, whereas Valsartan reduced myocardial scars and PVCs.
Do ARBs (Valsartan, Telmisartan) or PPAR agonists (Rosiglitazone) affect cardiac function, arrhythmias, and fibrosis in a preclinical model of arrhythmogenic cardiomyopathy?
In a preclinical model of arrhythmogenic cardiomyopathy, ARBs with PPARγ-activating properties like telmisartan may worsen arrhythmias and fibrosis, suggesting caution with their use in this patient population.
Absolute Event Rate: 74.8% vs 42.5%
Arrhythmogenic Cardiomyopathy (ACM) is a familial heart disease, characterized by contractile dysfunction, ventricular arrhythmias (VAs), and the risk of sudden cardiac death. Currently, implantable cardioverter defibrillators and antiarrhythmics are the mainstays in ACM therapeutics. Angiotensin receptor blockers (ARBs) have been highlighted in the treatment of heart diseases, including ACM. Yet, recent research has additionally implicated ARBs in the genesis of VAs and myocardial lipolysis via the peroxisome proliferator-activated receptor gamma (PPARγ) pathway. The latter is of particular interest, as fibrofatty infiltration is a pathological hallmark in ACM. Here, we tested two ARBs, Valsartan and Telmisartan, and the PPAR agonist, Rosiglitazone, in an animal model of ACM, homozygous Desmoglein-2 mutant mice (Dsg2mut/mut). Cardiac function, premature ventricular contractions (PVCs), fibrofatty scars, PPARα/γ protein levels, and PPAR-mediated mRNA transcripts were assessed. Of note, not a single mouse treated with Rosiglitazone made it to the study endpoint (i.e., 100% mortality: n = 5/5). Telmisartan-treated Dsg2mut/mut mice displayed the preservation of contractile function (percent ejection fraction %EF; 74.8 ± 6.8%EF) compared to Vehicle- (42.5 ± 5.6%EF) and Valsartan-treated (63.1 ± 4.4%EF) mice. However, Telmisartan-treated Dsg2mut/mut mice showed increased cardiac wall motion abnormalities, augmented %PVCs, electrocardiographic repolarization/depolarization abnormalities, larger fibrotic lesions, and increased expression of PPARy-regulated gene transcripts compared to their Dsg2mut/mut counterparts. Alternatively, Valsartan-treated Dsg2mut/mut mice harbored fewer myocardial scars, reduced %PVC, and increased Wnt-mediated transcripts. Considering our findings, caution should be taken by physicians when prescribing medications that may increase PPARy signaling in patients with ACM.
Landim-Vieira et al. (Fri,) conducted a other in Arrhythmogenic Cardiomyopathy. Valsartan, Telmisartan, Rosiglitazone vs. Vehicle was evaluated on Contractile function (percent ejection fraction [%EF]). In an ACM mouse model, Telmisartan preserved contractile function (74.8% EF vs 42.5% for vehicle) but increased arrhythmias and fibrosis, whereas Valsartan reduced myocardial scars and PVCs.
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