Format

Send to

Choose Destination
J Heart Lung Transplant. 2017 Apr;36(4):380-385. doi: 10.1016/j.healun.2016.12.016. Epub 2016 Dec 30.

Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices.

Author information

1
Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: houstobr@musc.edu.
2
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.
3
Department of Critical Care Medicine, National Institutes of Health, Bethesda, Maryland.
4
Division of Gastroenterology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
5
Department of Cardiac Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
6
Department of Cardiothoracic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
7
Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.

Abstract

BACKGROUND:

Angiogenesis is implicated in formation of gastrointestinal arteriovenous malformations (AVMs). Angiotensin II signaling is involved in angiogenesis through the vascular endothelial growth factor (VEGF) and angiopoietin-2 pathways. We hypothesized that angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy would be associated with a reduced risk of all-cause gastrointestinal bleeding (GIB) and AVM-associated GIB in patients with left ventricular assist devices (LVADs).

METHODS:

We reviewed records of all adult patients receiving a continuous-flow LVAD (HeartMate II or HeartWare HVAD) at Johns Hopkins Hospital between January 2004 and December 2014. Of 192 patients, 131 were included for final analyses. Logistic regression analysis adjusting for demographic, cardiovascular, and laboratory variables was used to assess the association of ACEI or ARB therapy with GIB.

RESULTS:

Of 131 patients, 100 received ACEI or ARB therapy during LVAD support. Of the 31 patients who did not receive ACEI or ARB, 15 experienced GIB (48%), with 9 caused by AVMs (29%). Of 100 patients who received ACEI or ARB therapy, 24 experienced GIB (24%), with 9 caused by AVMs (9%). Logistic regression hazards model demonstrated that ACEI or ARB therapy was independently associated with a reduced risk for all-cause GIB (odds ratio 0.29, 95% confidence interval 0.12-0.72) and AVM-related GIB (odds ratio 0.23, 95% confidence interval 0.07-0.71).

CONCLUSIONS:

Angiotensin II antagonism is associated with a reduced risk of AVM-related GIB in patients with LVADs. This association is independent of age, sex, blood pressure, renal function, international normalized ratio, LVAD type, and cardiomyopathy etiology.

KEYWORDS:

ACE inhibitor; ARB; Arteriovenous malformations; GI bleed; LVAD

PMID:
28169115
DOI:
10.1016/j.healun.2016.12.016
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center