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Angiotensin-Converting Enzyme Inhibition Early After Heart Transplantation.

Abstract：

BACKGROUND: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. OBJECTIVES:This study tested the safety and efficacy of the ACEI ramipril on the development of CAV early after HT. METHODS: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. RESULTS: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. CONCLUSIONS: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).

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Fearon WF,Okada K,Kobashigawa JA,Kobayashi Y,Luikart H,Sana S,Daun T,Chmura SA,Sinha S,Cohen G,Honda Y,Pham M,Lewis DB,Bernstein D,Yeung AC,Valantine HA,Khush K

doi

10.1016/j.jacc.2017.03.598

subject

Has Abstract

pub_date

2017-06-13 00:00:00

pages

2832-2841

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(17)37002-X

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Angiotensin-Converting Enzyme Inhibition Early After Heart Transplantation.