Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
Centre de Recherche Cardiovasculaire de Paris, U970, INSERM, Paris, France.
Heart. 2021 Sep;107(17):1384-1389. doi: 10.1136/heartjnl-2020-318787. Epub 2021 May 6.
To date, clinical trials have been underpowered to demonstrate a benefit from ACE inhibitors (ACEis) or angiotensin II receptor blockers (ARBs) in preventing systemic right ventricle (sRV) failure and disease progression in patients with transposition of the great arteries (TGA). This observational study aimed to estimate the effect of ACEi and ARB on heart failure (HF) incidence and mortality in a large population of patients with an sRV.
Data on all patients with an sRV under active follow-up at two tertiary centres between January 2007 and September 2018 were studied. The effect of ACEi and ARB on the incidence of HF and mortality was estimated using a propensity score weighting approach to control confounding.
Among the 359 patients with an sRV (32.2 (IQR 26.4-38.3) years, 59.3% male, 66% complete TGA with atrial switch repair and 34% congenitally corrected TGA), 79 (22%) had a moderate to severe sRV dysfunction and 138 (38%) were treated with ACEi or ARB. Fourteen (3.6%) patients died, 8 (2.1%) underwent heart transplantation and 46 (11.8%) had a new HF event over a median follow-up of 7.1 (IQR 4.0-9.4) years. On multivariate Cox analysis with adjustment using propensity score weighting approaches, ACEi or ARBs treatment was not significantly associated with a lower HF incidence or mortality in patients with an sRV.
Despite significant neurohormonal activation described in patients with an sRV, there is still no evidence of a beneficial effect of ACEi or ARB on morbidity and mortality in this population.
迄今为止，临床试验的效力还不足以证明 ACE 抑制剂（ACEi）或血管紧张素 II 受体阻滞剂（ARB）在预防大动脉转位（TGA）患者的系统性右心室（sRV）衰竭和疾病进展方面的获益。这项观察性研究旨在评估 ACEi 和 ARB 对大量 sRV 患者心力衰竭（HF）发病率和死亡率的影响。
研究了 2007 年 1 月至 2018 年 9 月期间在两个三级中心接受积极随访的所有 sRV 患者的数据。使用倾向评分加权方法来控制混杂因素，估计 ACEi 和 ARB 对 HF 发病率和死亡率的影响。
在 359 名 sRV 患者（32.2（IQR 26.4-38.3）岁，59.3%为男性，66%为完全 TGA 伴心房转换修复，34%为先天性矫正 TGA）中，79 例（22%）有中度至重度 sRV 功能障碍，138 例（38%）接受 ACEi 或 ARB 治疗。14 例（3.6%）患者死亡，8 例（2.1%）接受心脏移植，46 例（11.8%）在中位随访 7.1（IQR 4.0-9.4）年后发生新的 HF 事件。多变量 Cox 分析采用倾向评分加权方法进行调整，ACEi 或 ARB 治疗与 sRV 患者 HF 发病率或死亡率降低无关。
尽管 sRV 患者存在明显的神经激素激活，但 ACEi 或 ARB 对该人群的发病率和死亡率仍无获益证据。
