Latest insights in therapeutic options for systemic right ventricular failure: a comparison with left ventricular failure

Winter, Michiel M.; Bouma, Berto J.; Groenink, Maarten; Konings, T.C.; Tijssen, J.G.P.; Veldhuisen, D.J. van; Mulder, Barbara J.M.

doi:10.1136/hrt.2008.156265

Cited by 63 publications

(40 citation statements)

References 40 publications

(32 reference statements)

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“…26 The aim of the present study was to perform a larger trial with longer follow-up and quantitative measurement of right ventricular ejection fraction (RVEF) with magnetic resonance imaging.…”

Section: Editorial See P 314 Clinical Perspective On P 330mentioning

confidence: 99%

“…Because angiotensin II receptor density is similar in both the left and right ventricles, and neurohormonal activity is similar to that observed in patients with stable heart failure, one would expect a similar effect. [25][26][27] However, in 2 small placebo-controlled trials (n=17 and n=29, respectively), RAAS inhibition had no beneficial effect on exercise capacity, right ventricular function, or remodeling. 28,29 These studies, on the other hand, had only short-term follow-up and low patient numbers.…”

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confidence: 99%

“…[30][31][32] A complete overview of all studies on RAAS inhibition in patients with a systemic right ventricle published to date is presented in online-only Data Supplement Table I. 26 The aim of the present study was to perform a larger trial with longer follow-up and quantitative measurement of right ventricular ejection fraction (RVEF) with magnetic resonance imaging.…”

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confidence: 99%

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Effect of Valsartan on Systemic Right Ventricular Function

et al. 2013

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Editorial see p 314 Clinical Perspective on p 330In both asymptomatic and symptomatic patients with systemic left ventricular dysfunction, inhibition of the reninangiotensin aldosterone system (RAAS) decreases both Background-The role of angiotensin II receptor blockers in patients with a systemic right ventricle has not been elucidated. Methods and Results-We conducted a multicenter, double-blind, parallel, randomized controlled trial of angiotensin II receptor blocker valsartan 160 mg twice daily compared with placebo in patients with a systemic right ventricle caused by congenitally or surgically corrected transposition of the great arteries. The primary end point was change in right ventricular ejection fraction during 3-year follow-up, determined by cardiovascular magnetic resonance imaging or, in patients with contraindication for magnetic resonance imaging, multirow detector computed tomography. Secondary end points were change in right ventricular volumes and mass, V · o 2 peak, and quality of life. Primary analyses were performed on an intention-to-treat basis. A total of 88 patients (valsartan, n=44; placebo, n=44) were enrolled in the trial. No serious adverse effects occurred in either group. There was no significant effect of 3-year valsartan therapy on systemic right ventricular ejection fraction (treatment effect, 1.3%; 95% confidence interval, −1.3% to 3.9%; P=0.34), maximum exercise capacity, or quality of life. There was a larger increase in right ventricular end-diastolic volume (15 mL; 95% confidence interval, 3-28 mL; P<0.01) and mass (8 g; 95% confidence interval, 2-14 g; P=0.01) in the placebo group than in the valsartan group. Conclusions-There was no significant treatment effect of valsartan on right ventricular ejection fraction, exercise capacity, or quality of life. Valsartan was associated with a similar frequency of significant clinical events as placebo. Small but significant differences between valsartan and placebo were present for change in right ventricular volumes and mass. Clinical Trial Registration-URL: http://www.controlled-trials.com. Unique identifier: ISRCTN52352170. 17,20,21 In asymptomatic patients, on the other hand, there was no effect on ventricular function, and the effect on ventricular remodeling was much less pronounced. [22][23][24] In patients with a systemic right ventricle, the role of pharmacological RAAS blockade has not been established. Because angiotensin II receptor density is similar in both the left and right ventricles, and neurohormonal activity is similar to that observed in patients with stable heart failure, one would expect a similar effect.25-27 However, in 2 small placebo-controlled trials (n=17 and n=29, respectively), RAAS inhibition had no beneficial effect on exercise capacity, right ventricular function, or remodeling. 28,29 These studies, on the other hand, had only short-term follow-up and low patient numbers. Moreover, predominantly asymptomatic patients were included. Results from retrospective and single-arm studies have been eq...

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Section: Editorial See P 314 Clinical Perspective On P 330mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Effect of Valsartan on Systemic Right Ventricular Function

et al. 2013

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“…Such mechanisms of sRV failure eventually lead to myocardial fibrosis, to which late sRV dysfunction is related, and the extent of fibrosis correlates with the electrophysiological parameters. 16 These features of sRV failure are similar to those of ischemic cardiomyopathy or end-stage cardiomyopathy. In fact, the MIRACLE study showed that the benefits of CRT with respect to the EF and reverse remodeling were greater in patients with non-ischemic heart failure than ischemic heart failure.…”

Section: Acute Hemodynamic Studymentioning

confidence: 53%

Cardiac Resynchronization Therapy for Various Systemic Ventricular Morphologies in Patients With Congenital Heart Disease

Sakaguchi

Miyazaki

Yamada

et al. 2015

Circ J

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“…Other studies in adults with a systemic right ventricle have failed to demonstrate improvement in right ventricular ejection fraction with enalapril 49 or to demonstrate improvement in exercise capacity or N-terminal pro-brain natriuretic peptide levels with losartan (Table). 15,50 Most recently, a double-blind, randomized, placebo-controlled pilot study in a group of young adults with a systemic right ventricle showed no benefit of valsartan over placebo with regard to right ventricular ejection fraction, exercise capacity, or quality of life. 17 Moreover, there are data to suggest that the right ventricles and LVs may be different in terms of gene expression, microRNA expression, and adaptation to fibrosis (Figure 1).…”

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confidence: 99%