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Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices.

Publication ,  Journal Article
Houston, BA; Schneider, ALC; Vaishnav, J; Cromwell, DM; Miller, PE; Faridi, KF; Shah, A; Sciortino, C; Whitman, G; Tedford, RJ; Stevens, GR ...
Published in: J Heart Lung Transplant
April 2017

BACKGROUND: Angiogenesis is implicated in formation of gastrointestinal arteriovenous malformations (AVMs). Angiotensin II signaling is involved in angiogenesis through the vascular endothelial growth factor (VEGF) and angiopoietin-2 pathways. We hypothesized that angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy would be associated with a reduced risk of all-cause gastrointestinal bleeding (GIB) and AVM-associated GIB in patients with left ventricular assist devices (LVADs). METHODS: We reviewed records of all adult patients receiving a continuous-flow LVAD (HeartMate II or HeartWare HVAD) at Johns Hopkins Hospital between January 2004 and December 2014. Of 192 patients, 131 were included for final analyses. Logistic regression analysis adjusting for demographic, cardiovascular, and laboratory variables was used to assess the association of ACEI or ARB therapy with GIB. RESULTS: Of 131 patients, 100 received ACEI or ARB therapy during LVAD support. Of the 31 patients who did not receive ACEI or ARB, 15 experienced GIB (48%), with 9 caused by AVMs (29%). Of 100 patients who received ACEI or ARB therapy, 24 experienced GIB (24%), with 9 caused by AVMs (9%). Logistic regression hazards model demonstrated that ACEI or ARB therapy was independently associated with a reduced risk for all-cause GIB (odds ratio 0.29, 95% confidence interval 0.12-0.72) and AVM-related GIB (odds ratio 0.23, 95% confidence interval 0.07-0.71). CONCLUSIONS: Angiotensin II antagonism is associated with a reduced risk of AVM-related GIB in patients with LVADs. This association is independent of age, sex, blood pressure, renal function, international normalized ratio, LVAD type, and cardiomyopathy etiology.

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Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

April 2017

Volume

36

Issue

4

Start / End Page

380 / 385

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Logistic Models
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Gastrointestinal Hemorrhage
  • Female
 

Citation

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Houston, B. A., Schneider, A. L. C., Vaishnav, J., Cromwell, D. M., Miller, P. E., Faridi, K. F., … Rouf, R. (2017). Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. J Heart Lung Transplant, 36(4), 380–385. https://doi.org/10.1016/j.healun.2016.12.016
Houston, Brian A., Andrea L. C. Schneider, Joban Vaishnav, David M. Cromwell, P Elliott Miller, Kamil F. Faridi, Ashish Shah, et al. “Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices.J Heart Lung Transplant 36, no. 4 (April 2017): 380–85. https://doi.org/10.1016/j.healun.2016.12.016.
Houston BA, Schneider ALC, Vaishnav J, Cromwell DM, Miller PE, Faridi KF, et al. Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. J Heart Lung Transplant. 2017 Apr;36(4):380–5.
Houston, Brian A., et al. “Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices.J Heart Lung Transplant, vol. 36, no. 4, Apr. 2017, pp. 380–85. Pubmed, doi:10.1016/j.healun.2016.12.016.
Houston BA, Schneider ALC, Vaishnav J, Cromwell DM, Miller PE, Faridi KF, Shah A, Sciortino C, Whitman G, Tedford RJ, Stevens GR, Judge DP, Russell SD, Rouf R. Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. J Heart Lung Transplant. 2017 Apr;36(4):380–385.
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

April 2017

Volume

36

Issue

4

Start / End Page

380 / 385

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Logistic Models
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Gastrointestinal Hemorrhage
  • Female