The renin-angiotensin system and right ventricular structure and function: The MESA-Right Ventricle Study

Area of Science:

• Cardiology
• Pharmacology
• Vascular Biology

Background:

• The pulmonary vasculature is a key site for renin-angiotensin system (RAS) metabolism.
• Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (AIABs) are established treatments for left ventricular (LV) disease.
• The effect of AIABs on right ventricular (RV) function remains largely unknown.

Purpose of the Study:

• To investigate the association between AIAB use and RV structure and function.
• To determine if these associations differ by race/ethnicity.
• To explore the potential role of the RAS in RV remodeling.

Main Methods:

• Retrospective analysis of data from the Multi-Ethnic Study of Atherosclerosis.
• AIAB use determined from baseline medication inventory.
• RV measures (mass, end-diastolic volume) assessed using cardiac magnetic resonance imaging.
• Multivariable linear regression analyses, stratified by race/ethnicity and adjusted for covariates.

Main Results:

• AIAB use was associated with significantly lower RV mass in African Americans (P=0.03) after covariate adjustment.
• AIAB use was associated with significantly larger RV end-diastolic volume in Caucasians (P=0.02) after covariate adjustment.
• No significant associations were observed in Hispanic or Chinese American participants or for other RV measures.

Conclusions:

• AIAB use is associated with RV morphology in a race-specific manner, independent of LV characteristics.
• These findings suggest a potential unique role for the RAS in RV structure and function.
• Further research is warranted to explore AIAB use in patients with RV dysfunction.