Effect of Losartan or Atenolol on Children and Young Adults With Bicuspid Aortic Valve and Dilated Aorta

Am J Cardiol. 2021 Apr 1;144:111-117. doi: 10.1016/j.amjcard.2020.12.050. Epub 2020 Dec 29.

Abstract

Bicuspid aortic valve aortopathy is defined by dilation of the aortic root (AoRt) and/or ascending aorta (AsAo), and increases risk for aortic aneurysm and dissection. The effects of medical prophylaxis on aortic growth rates in moderate to severe bicuspid aortopathy have not yet been evaluated. This was a single-center retrospective study of young patients (1 day to 29 years) with bicuspid aortopathy (AoRt or AsAo z-score ≥ 4 SD, or absolute dimension ≥ 4 cm), treated with either losartan or atenolol. Maximal diameters and BSA-adjusted z-scores obtained from serial echocardiograms were utilized in a mixed linear effects regression model. The primary outcome was the annual rate of change in AoRt and AsAo z-scores during treatment, compared with before treatment. The mean ages (years) at treatment initiation were 14.2 ± 5.1 (losartan; n = 27) and 15.2 ± 4.9 (atenolol; n = 18). Median treatment duration (years) was 3.1 (IQR 2.4, 6.0) for losartan, and 3.7 (IQR 1.4, 6.6) for atenolol. Treatment was associated with decreases in AoRt and AsAo z-scores (SD/year), for both losartan and atenolol (pre- vs post-treatment): losartan/AoRt: +0.06 ± 0.02 vs -0.14 ± 0.03, p < 0.001; losartan/AsAo: +0.20 ± 0.03 vs -0.09 ± 0.05, p < 0.001; atenolol/AoRt: +0.07 ± 0.03 vs -0.02 ± 0.04, p = 0.04; atenolol/AsAo: +0.21 ± 0.04 vs -0.06 ± 0.06, p < 0.001. Treatment was also associated with decreases in absolute growth rates (cm/year) for all comparisons (p ≤ 0.02). Medical prophylaxis reduced proximal aortic growth rates in young patients with at least moderate and progressive bicuspid aortopathy.

MeSH terms

  • Adolescent
  • Adrenergic beta-1 Receptor Antagonists / therapeutic use*
  • Adult
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Aortic Diseases / drug therapy*
  • Aortic Diseases / etiology
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Stenosis / physiopathology
  • Atenolol / therapeutic use*
  • Bicuspid Aortic Valve Disease / complications
  • Bicuspid Aortic Valve Disease / drug therapy*
  • Bicuspid Aortic Valve Disease / physiopathology
  • Child
  • Child, Preschool
  • Dilatation, Pathologic / drug therapy
  • Dilatation, Pathologic / etiology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Losartan / therapeutic use*
  • Male
  • Pilot Projects
  • Retrospective Studies
  • Young Adult

Substances

  • Adrenergic beta-1 Receptor Antagonists
  • Angiotensin II Type 1 Receptor Blockers
  • Atenolol
  • Losartan