Abstract 3114: Progression of Aortic Stenosis is slowed by Angiotensin-Converting Enzyme Inhibition but not by Angiotensin II Type 1 Receptor Blockade
Background: Aortic valve sclerosis gradually but consistently progresses with aging, resulting in a frequent consequent aortic stenosis (AS) in the aged population. Recent clinical studies suggest that angiotensin converting enzyme inhibition (ACEI) likely slows the progression of AS but there are no data in terms of angiotensin II type 1 receptor blockade (ARB). Thus, we retrospectively reviewed the data of serially performed routine echo-Doppler studies to assess the yearly progression rate of peak flow velocity across the aortic valve (AFV) and the trans-aortic pressure gradient (ΔP) in Japanese population. In addition, the effect of long-term ACEI and/or ARB on the progression rate was also analyzed.
Methods and Results: The candidates of the study were 277consecutive pts with AFV of 2.0 m/sec or greater between 2/1/2005 and 2/28/2006 in echo lab of Hyogo Collage of Medicine. These patients met the following exclusion criteria:
those with artificial valve,
LV ejection fraction of 50% or less,
association of moderate or severe aortic regurgitation, and
lack of the previous data 6 months ago or earlier.
Finally 230 pts were the subjects of the study. There were 93 females and 137males, aged 71±11 years. Mean yearly change in AFV was .10 ± .30 m/s/year. ΔP was determined from AFV using a simplified Bernoulli equation. Yearly changes in AFV and ΔP were calculated using the serial data. The yearly change in ΔP was1.8 ± 6.0 mmHg/year. The changes in AFV and ΔP were reduced in those with chronic ACEI and in those with both ACEI and ARB. In contrast, they were not reduced in those with chronic ARB. Regression of oxidative stress through the bradykinin-NO pathway is known as an ACEI specific action in the vascular endothelium; this may have at least partially contributed to the beneficial effect of ACEI compared with ARB.
Conclusions: Although AS progression was slowed by chronic ACEI, it was not slowed by chronic ARB.