Losartan vs. Atenolol in Marfan Syndrome - Losartan vs. Atenolol in Marfan Syndrome

Description:

The goal of the trial was to evaluate an angiotensin-receptor blocker compared with a beta-blocker among patients with Marfan syndrome.

Contribution to the Literature: This trial failed to demonstrate superiority of losartan at preventing progression of aortic root dilatation.

Study Design

  • Randomized
  • Parallel

Patients with Marfan syndrome were randomized to losartan (n = 70) vs. atenolol (n = 70). Maximum dose was 100 mg/day.

  • Total number of enrollees: 140
  • Duration of follow-up: 3 years
  • Mean patient age: 26 years
  • Percentage female: 66%

Inclusion criteria:

  • Patients with Marfan syndrome
  • Ages 5-60 years
  • Maximum aortic dilatation <45 mm

Exclusion criteria:

  • History of aortic dissection
  • History of cardiac/aortic surgery
  • Grade III/IV aortic regurgitation
  • History of angioedema or intolerance to angiotensin-receptor blockers or beta-blockers
  • Pregnancy
  • Asthma or respiratory failure
  • Renal or neurological disease

Principal Findings:

The primary outcome, change in aortic root diameter at 36 months, as assessed by cardiac magnetic resonance imaging, was 1.1 mm in the losartan group vs. 1.4 mm in the atenolol group (p = 0.38).

Secondary outcomes:

  • Change in aortic root diameter indexed by body surface area at 36 months: -0.9 mm/m2 in the losartan group vs. -0.4 mm/m2 in the atenolol group (p = 0.092)
  • Change in ascending aorta diameter at 36 months: -0.1 mm in the losartan group vs. 0.0 mm in the atenolol group (p = 0.85)
  • Change in ascending aorta diameter indexed by body surface area at 36 months: -1.1 mm/m2 in the losartan group vs. -0.8 mm/m2 in the atenolol group (p = 0.33)
  • Aortic events: One patient in the losartan group vs. four patients in the atenolol group (p = 0.37)

Interpretation:

Among individuals with Marfan syndrome, losartan failed to prevent aortic root or ascending aorta dilatation compared with atenolol. Aortic events were similar between the groups. Beta-blocker therapy remains the standard treatment to prevent aortic complications among Marfan patients.  

References:

Forteza A, Evangelista A, Sánchez V, et al. Efficacy of losartan vs. atenolol for the prevention of aortic dilation in Marfan syndrome: a randomized clinical trial. Eur Heart J 2015;Oct 29:[Epub ahead of print].

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Imaging, CHD & Pediatrics and Interventions, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Magnetic Resonance Imaging

Keywords: Adrenergic beta-Antagonists, Aortic Diseases, Atenolol, Cardiac Surgical Procedures, Dilatation, Heart Defects, Congenital, Heart Valve Diseases, Losartan, Magnetic Resonance Imaging, Marfan Syndrome, Secondary Prevention


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