3-Month Enalapril Treatment in Pediatric Fontan Patients With Moderate to Good Systolic Ventricular Function.

Autor: Harteveld LM; The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands; Division of Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: L.M.Harteveld@LUMC.nl., Blom NA; The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands; Division of Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands; Department of Pediatric Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands., Terol Espinosa de Los Monteros C; The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands; Division of Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands., Kuipers IM; The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands; Division of Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands., Rammeloo LAJ; The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands; Division of Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands., Hazekamp MG; The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands., van Dijk JG; Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands., Ten Harkel ADJ; The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands; Division of Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2022 Jan 15; Vol. 163, pp. 98-103. Date of Electronic Publication: 2021 Nov 10.
DOI: 10.1016/j.amjcard.2021.10.013
Abstrakt: Many Fontan patients with and without systolic ventricular dysfunction are being treated with angiotensin-converting enzyme (ACE) inhibitors, despite its effectiveness remaining unclear. In the present study, we evaluated the short-term effect of enalapril on exercise capacity, vascular and ventricular function in pediatric Fontan patients with moderate-good systolic ventricular function. Fontan patients between 8 and 18 years with moderate-good systolic ventricular function and without previous ACE inhibitor treatment were included and were treated with enalapril for 3 months. During the first 2 weeks, the dosage was titrated according to systolic blood pressure (SBP). Exercise tests, ventricular function assessed by echocardiography, arterial stiffness measurements, and plasma levels of N-terminal pro-B-type natriuretic peptide assessed before and after a 3-month enalapril treatment period was compared. A total of 28 Fontan patients (median age 13.9 years, 6 to 15 years after Fontan operation) completed the study with a mean dosage of 0.3 ± 0.1 mg/kg/d. A total of 6 patients (21%) experienced a significant drop in SBP and 6 others (21%) experienced other adverse events. Enalapril treatment lowered the SBP (from 110 to 104 mmHg, p = 0.003) and levels of N-terminal pro-B-type natriuretic peptide (from 80 to 72 ng/L, p = 0.036). However, enalapril treatment did not improve exercise capacity, ventricular function, or arterial stiffness. In conclusion, short-term ACE inhibition has no beneficial effect in Fontan patients with moderate-good systolic ventricular function.
Competing Interests: Disclosures The authors have no conflicts of interest to declare.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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