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Angiotensin converting enzyme inhibitors and interstage failure in infants with hypoplastic left heart syndrome
Doris P Yimgang1, John D Sorkin2, Charles F Evans3
1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Insights
Angiotensin converting enzyme inhibitors did not improve interstage outcomes in infants with hypoplastic left heart syndrome. This study found no significant benefit in reducing interstage failure for these single ventricle defect patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Pharmacological Interventions in Neonates
Background:
- Angiotensin converting enzyme inhibitors (ACEIs) are frequently prescribed post-Norwood procedure for single ventricle defects.
- Limited data exist on the efficacy of ACEIs in improving interstage outcomes for these vulnerable infants.
- Hypoplastic left heart syndrome (HLHS) is a critical congenital heart defect requiring complex surgical palliation.
Purpose of the Study:
- To investigate the association between ACEI use and interstage failure in infants with HLHS.
- To evaluate the impact of ACEIs on adverse outcomes between the first and second stages of surgical palliation.
- To provide evidence-based guidance on ACEI therapy in HLHS management.
Main Methods:
- Retrospective cohort study utilizing the National Pediatric Cardiology Quality Improvement Collaborative database (2008-2015).
- Logistic regression models and propensity score matching were employed to analyze exposure-outcome associations and control for confounding variables.
- Inclusion criteria comprised neonates diagnosed with hypoplastic left heart syndrome.
Main Results:
- The study included 1,487 neonates; 39% received ACEIs post-Norwood procedure.
- Interstage failure (death, transplant, or ineligibility for Stage 2 surgery) occurred in 11% of patients.
- While unadjusted analysis showed higher failure rates with ACEIs (OR=1.44), propensity score matching revealed no significant difference (aOR=1.29, P=0.18).
Conclusions:
- ACEI therapy did not demonstrate a significant beneficial effect on reducing interstage failure in infants with HLHS.
- Even after accounting for patient characteristics, ACEIs did not improve outcomes in this high-risk population.
- Further research may be needed to explore alternative or adjunctive therapies for optimizing interstage care in single ventricle physiology.
Introduction:
Angiotensin converting enzyme inhibitors are commonly prescribed medications after the Norwood procedure. There are little data that can be used to determine if angiotensin converting enzyme inhibitors improve interstage outcomes in children with single ventricle defects. The objective of this study was to investigate the relationship between angiotensin converting enzyme inhibitors and interstage failure among infants born with hypoplastic left heart syndrome.
Methods:
We conducted a retrospective cohort study using data from the National Pediatric Cardiology Quality Improvement Collaborative database (collected between 2008 and 2015). We used logistic regression models to assess the exposure-outcome associations and propensity score matching to account for differences in baseline patient characteristics associated with use of angiotensin converting enzyme inhibitors.
Results:
A total of 1 487 neonates participated in the study. Thirty-nine percent of patients were prescribed angiotensin converting enzyme inhibitors after the Norwood procedure; 11% experienced interstage failure (death, heart transplantation, and not being a candidate for the second-stage surgery). Before propensity score matching, patients receiving angiotensin converting enzyme inhibitors were significantly more likely to experience interstage failure, compared to patients not on angiotensin converting enzyme inhibitors (OR = 1.44; 95% CI: 1.04, 1.99; P = 0.03). Although there was an increased odds of interstage failure among patients receiving angiotensin converting enzyme inhibitors compared to patients not receiving angiotensin converting enzyme inhibitors in the propensity score-matched cohort, this association was not significantly different (adjusted OR = 1.29; 95% CI: 0.88, 1.95; P = 0.18).
Conclusion:
Angiotensin converting enzyme inhibitor therapy did not demonstrate a beneficial effect on interstage failure among infants with hypoplastic left heart syndrome, even when patient characteristics associated with the use of angiotensin converting enzyme inhibitors were considered.
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