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Effect of candesartan treatment on left ventricular remodeling after aortic valve replacement for aortic stenosis

Jordi S Dahl1, Lars Videbaek, Mikael K Poulsen

  • 1Department of Cardiology, Odense University Hospital, Denmark.

The American Journal of Cardiology
|August 21, 2010
PubMed

Insights

Angiotensin receptor blockers like candesartan significantly improved left ventricular (LV) and left atrial (LA) reverse remodeling after aortic valve replacement (AVR) for aortic stenosis (AS). This treatment augmented LV mass reduction and improved LV systolic function compared to conventional therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Imaging

Background:

  • Severe aortic stenosis (AS) often leads to left ventricular (LV) hypertrophy.
  • Angiotensin receptor blockers (ARBs) are known to promote LV regression in hypertension.
  • The effect of ARBs on reverse remodeling post-aortic valve replacement (AVR) for AS is not well-established.

Purpose of the Study:

  • To investigate if candesartan, an ARB, enhances LV and left atrial (LA) reverse remodeling after AVR in patients with AS.
  • To compare the effects of candesartan plus conventional therapy versus conventional therapy alone on cardiac remodeling post-AVR.

Main Methods:

  • A randomized controlled trial involving 114 patients scheduled for AVR due to severe AS.
  • Patients received either candesartan 32 mg daily or conventional therapy post-AVR.
  • Echocardiographic evaluations were performed at 3, 6, and 12 months to assess LV mass index, LV systolic function, and LA volume.

Main Results:

  • The candesartan group showed a significantly greater reduction in LV mass index compared to the control group (30 +/- 40 g/m(2) vs 12 +/- 28 g/m(2), p = 0.015).
  • After 12 months, LV mass index was significantly lower in the candesartan group (103 +/- 29 vs 119 +/- 31 g/m(2), p = 0.01).
  • Enhanced longitudinal LV systolic function (tissue Doppler S' wave) and decreased LA volume were observed in the candesartan group (p = 0.01, p for trend = 0.01).

Conclusions:

  • Candesartan treatment following AVR in patients with AS promotes augmented reverse LV and LA remodeling.
  • ARBs represent a potential therapeutic strategy to improve cardiac remodeling after AVR in AS patients.
  • Further research may explore long-term outcomes and optimal ARB use in this population.

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