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Safety and efficacy of angiotensin-converting enzyme inhibitors in symptomatic severe aortic stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS).
Am Heart J. 2004 Apr; 147(4):E19.AH

Abstract

BACKGROUND

Animal models have demonstrated a benefit of angiotensin-converting enzyme inhibitors (ACEI) in experimental aortic stenosis (AS), and intravenous nitroprusside has shown hemodynamic improvements in AS with left ventricular (LV) dysfunction. Although routinely used in most heart failure situations, ACEI are avoided in AS because of the risk of hypotension. We aimed to determine the clinical tolerance and efficacy of the ACEI enalapril in the setting of symptomatic severe AS.

METHODS

Patients with symptomatic severe AS were enrolled in a randomized, double-blinded, controlled trial to enalapril or placebo arms after initial stabilization. Standard antifailure medications were continued. Enalapril was started at 2.5 mg bid and increased to 10 mg bid. The primary end points were development of hypotension and improvements in Borg dyspnea index and 6-minute walk distance at 1 month. Secondary end points were minor ACEI intolerance, cough, presyncope, improvement in New York Heart Association class, and echocardiographic parameters.

RESULTS

Fifty-six patients were enrolled (37 in the enalapril arm and 19 in the placebo arm). Enalapril was tolerated without hypotension or syncope when LV systolic function was preserved. Three of 5 patients with LV dysfunction and congestive heart failure had hypotension and were withdrawn. Patients who tolerated enalapril (n = 34) demonstrated significant improvement in NYHA class, Borg index (5.4 +/- 1.2 vs 5.6 +/- 1.7, P =.03), and 6-minute walk distance (402 +/- 150 vs 376 +/- 174, P =.003) compared with control subjects. Within the enalapril group, patients with associated regurgitant lesions improved the most.

CONCLUSIONS

ACEI are well tolerated in symptomatic patients with severe AS. Patients with congestive heart failure with LV dysfunction and low normal blood pressure are prone to have hypotension. Enalapril significantly improves effort tolerance and reduces dyspnea in symptomatic AS.

Authors+Show Affiliations

Department of Cardiology, Madras Medical College and Research Institute, Chennai, India. drcanands@yahoo.co.inNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15077102

Citation

Chockalingam, Anand, et al. "Safety and Efficacy of Angiotensin-converting Enzyme Inhibitors in Symptomatic Severe Aortic Stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS)." American Heart Journal, vol. 147, no. 4, 2004, pp. E19.
Chockalingam A, Venkatesan S, Subramaniam T, et al. Safety and efficacy of angiotensin-converting enzyme inhibitors in symptomatic severe aortic stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS). Am Heart J. 2004;147(4):E19.
Chockalingam, A., Venkatesan, S., Subramaniam, T., Jagannathan, V., Elangovan, S., Alagesan, R., Gnanavelu, G., Dorairajan, S., Krishna, B. P., & Chockalingam, V. (2004). Safety and efficacy of angiotensin-converting enzyme inhibitors in symptomatic severe aortic stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS). American Heart Journal, 147(4), E19.
Chockalingam A, et al. Safety and Efficacy of Angiotensin-converting Enzyme Inhibitors in Symptomatic Severe Aortic Stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS). Am Heart J. 2004;147(4):E19. PubMed PMID: 15077102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and efficacy of angiotensin-converting enzyme inhibitors in symptomatic severe aortic stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS). AU - Chockalingam,Anand, AU - Venkatesan,S, AU - Subramaniam,T, AU - Jagannathan,V, AU - Elangovan,S, AU - Alagesan,R, AU - Gnanavelu,G, AU - Dorairajan,Smrita, AU - Krishna,B P, AU - Chockalingam,V, AU - ,, PY - 2004/4/13/pubmed PY - 2004/8/10/medline PY - 2004/4/13/entrez SP - E19 EP - E19 JF - American heart journal JO - Am Heart J VL - 147 IS - 4 N2 - BACKGROUND: Animal models have demonstrated a benefit of angiotensin-converting enzyme inhibitors (ACEI) in experimental aortic stenosis (AS), and intravenous nitroprusside has shown hemodynamic improvements in AS with left ventricular (LV) dysfunction. Although routinely used in most heart failure situations, ACEI are avoided in AS because of the risk of hypotension. We aimed to determine the clinical tolerance and efficacy of the ACEI enalapril in the setting of symptomatic severe AS. METHODS: Patients with symptomatic severe AS were enrolled in a randomized, double-blinded, controlled trial to enalapril or placebo arms after initial stabilization. Standard antifailure medications were continued. Enalapril was started at 2.5 mg bid and increased to 10 mg bid. The primary end points were development of hypotension and improvements in Borg dyspnea index and 6-minute walk distance at 1 month. Secondary end points were minor ACEI intolerance, cough, presyncope, improvement in New York Heart Association class, and echocardiographic parameters. RESULTS: Fifty-six patients were enrolled (37 in the enalapril arm and 19 in the placebo arm). Enalapril was tolerated without hypotension or syncope when LV systolic function was preserved. Three of 5 patients with LV dysfunction and congestive heart failure had hypotension and were withdrawn. Patients who tolerated enalapril (n = 34) demonstrated significant improvement in NYHA class, Borg index (5.4 +/- 1.2 vs 5.6 +/- 1.7, P =.03), and 6-minute walk distance (402 +/- 150 vs 376 +/- 174, P =.003) compared with control subjects. Within the enalapril group, patients with associated regurgitant lesions improved the most. CONCLUSIONS: ACEI are well tolerated in symptomatic patients with severe AS. Patients with congestive heart failure with LV dysfunction and low normal blood pressure are prone to have hypotension. Enalapril significantly improves effort tolerance and reduces dyspnea in symptomatic AS. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15077102/Safety_and_efficacy_of_angiotensin_converting_enzyme_inhibitors_in_symptomatic_severe_aortic_stenosis:_Symptomatic_Cardiac_Obstruction_Pilot_Study_of_Enalapril_in_Aortic_Stenosis__SCOPE_AS__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870303007336 DB - PRIME DP - Unbound Medicine ER -