P310 - IMPACT OF ANGIOTENSIN RECEPTOR ANTAGONIST IN MILD-TO-MODERATE AORTIC STENOSIS PATIENTS

Background: Hypertension and Angiotensin II have been associated with faster progression of aortic stenosis (AS) while Angiotensin II receptor antagonists (ARA) showed reduction in AS progression. However, the impact on left ventricular (LV) function was not described. We aimed to evaluate the impact of ARA on LV function and remodeling, as well as exercise capacity in mild to moderate AS patients.

METHODS AND RESULTS: We conducted a case-control study over 2 years which demonstrated decrease in progression of AS. 18 patients (50% women) were treated during 2 years by Losartan. Patients were matched 1:1 for sex (exact match), presence of diabetes (exact match), presence of atrial fibrillation (exact match), age (within 10 years), body mass index (BMI; within 3.33 kg/m2), AS severity based on mean gradient (within 3 mmHg) and effective orifice area (within 0.05 cm2), and LV ejection fraction (within 5%) to 18 controls followed prospectively for 2 years without treatment.
During the 2-year follow-up, there was no adverse event associated to the medication. Systolic blood pressures decreased more in ARA group compared to non-treated group (-21[-34– -12] vs -8[-32–22] mmHg, p=0.003). LV end diastolic diameter decreased in the ARA group (-1.2[-5.8–1.1] mm) and increased in the non-treated group (1.9[-0.2–2.7] mm, LVEF remained stable in both groups (+0[-5–2] vs +0[-3–2]%; p=0.70). However, global longitudinal strain increased from -18 to -15% (p=0.003) in non-treated group, while it remained stable in the ARA group (-15 to -16%, p=0.58). Finally, maximal exercise capacity remained stable in treated patients (Peak VO2: 14.1 ml/kg/min at baseline vs 14.2 ml/kg/min at 1 year).

Conclusion: In this prospective case-control study in hypertensive patients with mild to moderate AS, ARA was well tolerated. In addition to slow down AS progression, ARA was beneficial with regards to LV geometry and function. Further randomized control trial is needed to confirm the beneficial impact of ARA in AS.