Background 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.
Methods 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.
Results 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.
Conclusions 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.
- transposition of the great arteries
- heart failure
- heart failure
Data availability statement
No data are available.
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Contributors ML: contributed to conception or design; contributed to acquisition, analysis and interpretation; drafted the manuscript; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work ensuring integrity and accuracy. TSdlC, BG, AB-P, WL, LI, IR and AK: contributed to interpretation; critically revised the manuscript; and gave final approval. EV: contributed to the analysis of the data (statistical analysis). RL and AL: drafted the manuscript and gave final approval. EM, SVB-N and MAG: critically revised the manuscript and gave final approval. KD: contributed to conception or design; contributed to analysis and interpretation; drafted the manuscript; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work ensuring integrity and accuracy.
Funding This work was supported by the Fédération Française de Cardiologie, Assistance Publique des Hôpitaux de Paris and by the Fundación Alfonso Martín Escudero.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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