Long-term effect of angiotensin-converting enzyme inhibitor in volume overloaded heart during growth: a controlled pilot study

OBJECTIVES This study examined whether long-term therapy with an angiotensin-converting enzyme (ACE) inhibitor reduces excessive increases in left ventricular (LV) mass as well as volume in growing children with aortic regurgitation or mitral regurgitation. BACKGROUND The ACE inhibitor reduces volume overload and LV hypertrophy in adults with aortic or mitral regurgitation. METHODS This study included 24 patients whose ages ranged from 0.3 to 16 years at entry to the study. On echocardiography, we measured LV size, systolic function and mass. After obtaining baseline data, patients were allocated into two groups. Twelve patients were given an ACE inhibitor (ACE inhibitor group), and 12 patients were not (control group). Echo parameters were again assessed after an average 3.4 years of follow-up. RESULTS Left ventricular parameters at baseline in the two groups were similar. The Z value of LV end-diastolic dimensions decreased from +0.82 ± 0.55 to +0.57 ± 0.58 in the ACE inhibitor group, whereas it increased from +0.73 ± 0.85 to +1.14 ± 1.04 in the control group (mean change −0.25 ± 0.33 for the ACE inhibitor group vs. +0.42 ± 0.48 for the control group, p = 0.0007). The mass normalized to growth also reduced from 221 ± 93% to 149 ± 44% of normal in the ACE inhibitor group and increased from 167 ± 46% to 204 ± 59% of normal in the control group (mean change −72 ± 89% of normal for the ACE inhibitor group vs. +37 ± 35% of normal for the control group, p = 0.0007). CONCLUSIONS Long-term treatment with ACE inhibitors is effective in reducing not only LV volume overload but also LV hypertrophy in the hearts of growing children with LV volume overload.