Ohnemus Daniella, Oster Matthew E, Gatlin Scott, Jokhadar Maan, Mahle William T
Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
Congenit Heart Dis. 2015 Jan-Feb;10(1):E1-5. doi: 10.1111/chd.12184. Epub 2014 Apr 16.
Bicuspid aortic valve (BAV), the most common congenital heart defect, is associated with progressive aortic dilation and increased risk of dissection and rupture. The use of an angiotensin-converting enzyme (ACE) inhibitor has recently proven effective in slowing the rate of aortic dilation in other aortopathies, suggesting it may also be useful in managing BAV. We sought to determine whether ACE inhibitors effectively reduce the rate of aortic dilation in adolescents and young adults with BAV.
A retrospective cohort study was undertaken. Subjects receiving ACE inhibitor therapy were compared with controls with BAV and matched for the degree of aortic regurgitation. The rate of change in ascending aorta diameter was compared between the two groups.
Among the 141 subjects identified in the patient records, 103 were receiving no medication and 38 were taking ACE inhibitors. Over a mean follow-up of 37 months, the ascending aorta Z-score increased slightly among those receiving ACE inhibitor +4.5 ± 1.6 to +4.7 ± 1.6. The rate of change was no different than those subjects not receiving ACE inhibitors, P = .64.
In an adolescent and young adult population with an isolated BAV, there is no proven benefit to ACE inhibitor use with regard to slowing rate of ascending aortic dilation.
二叶式主动脉瓣（BAV）是最常见的先天性心脏缺陷，与主动脉进行性扩张以及夹层和破裂风险增加相关。最近已证明，使用血管紧张素转换酶（ACE）抑制剂可有效减缓其他主动脉病变中主动脉扩张的速度，这表明其可能也有助于治疗BAV。我们试图确定ACE抑制剂是否能有效降低患有BAV的青少年和年轻成年人的主动脉扩张速度。
进行了一项回顾性队列研究。将接受ACE抑制剂治疗的受试者与患有BAV且主动脉反流程度相匹配的对照组进行比较。比较两组升主动脉直径的变化率。
在患者记录中确定的141名受试者中，103名未接受药物治疗，38名正在服用ACE抑制剂。在平均37个月的随访中，接受ACE抑制剂治疗的患者升主动脉Z评分略有增加，从+4.5±1.6增至+4.7±1.6。变化率与未接受ACE抑制剂治疗的受试者无差异，P = 0.64。
在患有孤立性BAV的青少年和年轻成年人中，使用ACE抑制剂在减缓升主动脉扩张速度方面未显示出明显益处。
