Propensity Score Analysis of Possible Medication Effects on Outcomes in Patients With Systemic Right Ventricles Article

Full Text via DOI: 10.1016/j.jacadv.2024.101443 Web of Science: 001504271500003

Cited authors

  • Misra A, Rodriguez-Monserrate CP, Gauvreau K, Dellborg M, Fusco F, Gupta T, Kay J, Kutty S, Kauling RM, Nicolarsen J, Roos-Hesselink J, John AS, Wong J, Burchill LJ, Krieger EV, Lubert AM, Gallego P, Kuo M, Aboulhosn J, Cramer J, Antonova P, Baker D, Dehghani P, Opotowsky AR, van Dissel A, Grewal J, Yeung E, Fernandes S, Ginde S, Khairy P, Han F, Vonder Muhll I, Wilson WM, Aaron W, Pylypchuk S, Sarubbi B, O'Donnell C, Rodriguez F III, Jayadeva PS, Celermajer DS, Shah S, Cotts T, Dezorzi C, Magalski A, Valente AM, Broberg CS

Abstract

  • BACKGROUND Patients with systemic right ventricle (SRV), either d-transposition of the great arteries following an atrial switch procedure or congenitally corrected transposition of the great arteries, develop severe right ventricular dysfunction, prompting appropriate medical therapy. However, the efficacy of beta-blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in SRV patients is unproven. OBJECTIVES The objective of this study was to determine the effects of ACEI/ARB and beta-blockers on outcomes in SRV patients after accounting for likely cofounders affecting their use. METHODS From a retrospective, multicenter study on heart failure-related outcome in individuals with SRV, those who were taking an ACEI/ARB, beta-blocker, or both of these medication were identified. We performed a propensity analysis to match them to those not using these medications at their initial visit. Matching was based on a propensity score, which captured co-morbidities, demographics, and baseline echocardiographic parameters. Primary outcome of death, transplant, or mechanical circulatory support, and secondary outcomes of heart failure hospitalizations/atrial arrhythmias were analyzed respectively. RESULTS We identified 393 patients taking ACEI/ARB or beta-blocker, or taking both a beta-blocker and ACEI/ARB (62.1% male, median age 31.3 years) and 484 patients (56.4% male, median age of 26.0 years) who were neither on a beta-blocker nor on ACEI/ARB at the time of initial clinic visit. Median follow-up was w8 years. After propensity matching, medication use was not associated with decreased mortality, heart failure hospitalizations, or arrhythmias. Hazard ratios remained positive for beta blockers, implying potential harm rather than benefit. CONCLUSIONS In this large multicenter propensity-matched observational study, patients with SRV taking beta-blockers or ACEI/ARB did not have a benefit in survival or reduced hospitalization. The likelihood of demonstrating favorable effects in larger studies appears remote. (JACC Adv. 2025;4:101443) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Authors

Publication date

  • 2024

Number of pages

  • 9

Volume

  • 4

Issue

  • 1