Effects of Losartan on Left Ventricular Hypertrophy and Fibrosis in Patients With Nonobstructive Hypertrophic Cardiomyopathy

Yuichi J. Shimada, Jonathan J. Passeri, Aaron L. Baggish, Caitlin O'Callaghan, Patricia A. Lowry, Gia Yannekis, Suhny Abbara, Brian B. Ghoshhajra, Richard D. Rothman, Carolyn Y. Ho, James L. Januzzi, Christine E. Seidman, Michael A. Fifer

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48 Scopus citations

Abstract

Objectives: The aim of this study was to evaluate the effects of losartan on left ventricular (LV) hypertrophy and fibrosis in patients with nonobstructive hypertrophic cardiomyopathy (HCM). Background: Despite evidence that myocardial hypertrophy and fibrosis are mediated by angiotensin II and are important determinants of morbidity and mortality in patients with HCM, no prior studies have evaluated the effects of angiotensin receptor blockers on LV hypertrophy and fibrosis with cardiac magnetic resonance imaging. Methods: In double-blind fashion, 20 patients (3 women, 17 men; age: 51 ± 13 years) with HCM were randomly assigned to receive placebo (n= 9) or losartan 50 mg twice a day (n= 11) for 1 year. Cardiac magnetic resonance imaging was performed at baseline and 1 year to measure LV mass and extent of fibrosis as assessed by late gadolinium enhancement. Results: There was a trend toward a significant difference in the percent change in LV mass (median [interquartile range]:+5% [-4% to+21%] with placebo vs.-5% [-11% to-0.9%] with losartan; p= 0.06). There was a significant difference in the percent change in extent of late gadolinium enhancement, with the placebo group experiencing a larger increase (+31% ± 26% with placebo vs.-23% ± 45% with losartan; p= 0.03). Conclusions: This pilot study suggests attenuation of progression of myocardial hypertrophy and fibrosis with losartan in patients with nonobstructive HCM. Confirmation of these results in a larger trial is required to confirm a place for angiotensin receptor blockers in the management of patients with HCM. (Effect of Losartan in Patients With Nonobstructive Hypertrophic Cardiomyopathy; NCT01150461).

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalJACC: Heart Failure
Volume1
Issue number6
DOIs
Publication statusPublished - Dec 2013

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Keywords

  • Angiotensin II receptor blocker
  • Cardiac magnetic resonance imaging
  • Hypertrophic cardiomyopathy
  • Late gadolinium enhancement
  • Left ventricular fibrosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Shimada, Y. J., Passeri, J. J., Baggish, A. L., O'Callaghan, C., Lowry, P. A., Yannekis, G., ... Fifer, M. A. (2013). Effects of Losartan on Left Ventricular Hypertrophy and Fibrosis in Patients With Nonobstructive Hypertrophic Cardiomyopathy. JACC: Heart Failure, 1(6), 480-487. https://doi.org/10.1016/j.jchf.2013.09.001