Effect of angiotensin receptor blockade on systemic right ventricular function and size: A small, randomized, placebo-controlled study

Introduction: The effects of angiotensin converting enzyme inhibitor on systemic right ventricular size and function are unknown. Methods: Prospective, double blind, randomized, placebo-controlled clinical trial of 1-year therapy with Ramipril in adult patients with DTGA status postatrial baffle procedure. Primary endpoints were change in systemic right ventricular ejection fraction ( RVEF) and right ventricular size assessed by magnetic resonance imaging ( MRI). Results: Seventeen patients were enrolled into the study. Mean age at study enrollment was 26.4 +/- 5.2 years. Mean baseline RVEF was 44 +/- 6.5%, mean RVEDV was 206.3 +/- 75.5 ml. Eight patients were randomized to the treatment group and 9 patients were randomized to the placebo group. RVEF did not improve in the Ramipril group from baseline to 1 year ( 43.8 +/- 7.1% vs. 40.9 +/- 13.3%, p= 0.52) and remain unchanged in the placebo group ( 44.3 +/- 6.3 vs. 46.3 +/- 9.6%, p= 0.42). RVEDV ( 184.5 +/- 56.4 ml vs. 179.6 +/- 66.4 ml, p= 0.64) and RVESV ( 109.5 +/- 19.4 ml vs. 111.8 +/- 30.1, p= 0.74) remained unchanged in the Ramipril group from baseline to 1 year as well as in the placebo group ( 228.1 +/- 89.2 ml vs. 204.5 +/- 50.4 ml, p= 0.42 and 117.5 +/- 36.9 ml vs. 117.4 +/- 26.2 ml, p= 0.99, respectively). Conclusion: One-year treatment with Ramipril does not seem to affect right ventricular function or size in adult patients with systemic right ventricles after a Mustard or Senning procedure. Condensed abstract: 17 Adult patients ( mean age of 26.4 +/- 5.2years) with systemic right ventricles were blindly randomized to 1-year treatment with Ramipril placebo. Systemic right ventricular function ( RVEF) and size ( RVEDV) were assessed by magnetic resonance imaging at baseline and 1year. RVEF failed to improve in the Ramipril group ( 43.8 +/- 7.1% vs. 40.9 +/- 13.3%, p= 0.52) and remain unchanged in the placebo group ( 44.3 +/- 6.3 vs. 46.3 +/- 9.6%, p= 0.42). RVEDV remained unchanged in the study group ( 184.5 +/- 56.4ml vs. 179.6 +/- 66.4ml, p= 0.64 as well as in the placebo group ( 228.1 +/- 89.2ml vs. 204.5 +/- 50.4ml, p = 0.42). One-year treatment with Ramipril does not improve right ventricular function or attenuate remodeling in adult patients with systemic right ventricles. (C) 2008 Elsevier Ireland Ltd. All rights reserved.