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Angiotensin-Converting Enzyme Inhibition Early After Heart Transplantation.
- Source :
-
Journal of the American College of Cardiology (JACC) . Jun2017, Vol. 69 Issue 23, p2832-2841. 10p. - Publication Year :
- 2017
-
Abstract
- <bold>Background: </bold>Cardiac allograft vasculopathy (CAV) remains a leading cause of mortality after heart transplantation (HT). Angiotensin-converting enzyme inhibitors (ACEIs) may retard the development of CAV but have not been well studied after HT.<bold>Objectives: </bold>This study tested the safety and efficacy of the ACEI ramipril on the development of CAV early after HT.<bold>Methods: </bold>In this prospective, multicenter, randomized, double-blind, placebo-controlled trial, 96 HT recipients were randomized to undergo ramipril or placebo therapy. They underwent coronary angiography, endothelial function testing; measurements of fractional flow reserve (FFR) and coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR); and intravascular ultrasonography (IVUS) of the left anterior descending coronary artery, within 8 weeks of HT. At 1 year, the invasive assessment was repeated. Circulating endothelial progenitor cells (EPCs) were quantified at baseline and 1 year.<bold>Results: </bold>Plaque volumes at 1 year were similar between the ramipril and placebo groups (162.1 ± 70.5 mm3 vs. 177.3 ± 94.3 mm3, respectively; p = 0.73). Patients receiving ramipril had improvement in microvascular function as shown by a significant decrease in IMR (21.4 ± 14.7 to 14.4 ± 6.3; p = 0.001) and increase in CFR (3.8 ± 1.7 to 4.8 ± 1.5; p = 0.017), from baseline to 1 year. This did not occur with IMR (17.4 ± 8.4 to 21.5 ± 20.0; p = 0.72) or CFR (4.1 ± 1.8 to 4.1 ± 2.2; p = 0.60) in the placebo-treated patients. EPCs decreased significantly at 1 year in the placebo group but not in the ramipril group.<bold>Conclusions: </bold>Ramipril does not slow development of epicardial plaque volume but does stabilize levels of endothelial progenitor cells and improve microvascular function, which have been associated with improved long-term survival after HT. (Angiotensin Converting Enzyme [ACE] Inhibition and Cardiac Allograft Vasculopathy; NCT01078363). [ABSTRACT FROM AUTHOR]
- Subjects :
- *MORTALITY
*ACE inhibitors
*ULTRASONIC imaging
*LONGITUDINAL method
*CORONARY circulation
*COMPARATIVE studies
*CORONARY arteries
*GRAFT rejection
*HEART transplantation
*VASCULAR resistance
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*RESEARCH funding
*TIME
*RAMIPRIL
*EVALUATION research
*RANDOMIZED controlled trials
*TREATMENT effectiveness
*BLIND experiment
*CORONARY angiography
*PHYSIOLOGY
HEART transplantation complications
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 69
- Issue :
- 23
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 123255816
- Full Text :
- https://doi.org/10.1016/j.jacc.2017.03.598