Abstract 3392: Candesartan use in Hypertrophic and Non-obstructive Cardiomyopathy: a Double-Blind, Placebo-Controlled, Randomized, Multicenter Study
Background: Magnitude of left ventricular (LV) hypertrophy is one of the major determinants of symptoms and prognosis in hypertrophic cardiomyopathy (HCM). In a double-blind, placebo-controlled, randomized study, we tested the effects of angiotensin II type 1 receptor antagonist candesartan on LV hypertrophy in patients with non obstructive HCM.
Methods: Twenty-four consecutive genetically independent adult patients (age 43±13 yrs; 46% males) with non obstructive HCM were randomly assigned in 1:1 ratio either to candesartan or placebo. At baseline, patients underwent mutational analysis, bicycle ergometry and echocardiography. Ergometry and echocardiography was repeated 12 months after the maintenance dose of study drug was reached.
Results: No patient developed LV outflow tract obstruction or any other side effects during up-titration of study drug and follow-up. Target dose of study drug (32 mg daily) was reached in 8 (67%) and 9 (75%) patients in candesartan and placebo group, respectively (ns). At 12-month follow-up, patients on candesartan showed significant reduction of LV mass as compared to patients recieving placebo (−15.4% vs. −0.05%. p=0.04) with the greatest effect in carries of ß-myosin heavy chain mutation (−23%) (Table 1⇓). Furthermore, candesartan use was associated, with significant increase in peak mitral annular systolic (Sa) and diastolic (Ea) velocity (+34,4% and +45,4%, respectively), decrease (−31,1%) in LV filling pressures (E/Ea) and increase (+30,8%) in total exercise time between baseline and follow-up (all p<0.01). In contrast, no significant improvement in these parameters was observed in the placebo group.
Conclusions: In non obstructive HCM, candesartan induced significant regression of LV hypertrophy, improvement of LV function and exercise tolerance with no side effects.