https://doi.org/10.55788/42ff64c9
The connective tissue disorder, Marfan syndrome, is associated with characteristic aortic root enlargement, which increases the risk of life-threatening aortic dissection and rupture, sometimes in early adulthood. Elective surgery to replace the aortic root is often discussed with the patient when the aortic root reaches 4.5–5 cm. Limited previous data has led to the recommendation of using beta-blockers to retard aortic growth. However, some clinical evidence also suggests that ARBs might slow aortic root growth in Marfan syndrome.
The Marfan Treatment Trialists’ (MTT) Collaboration set out to retrospectively determine the effects of ARBs and beta-blockers on aortic root growth by means of a meta-analysis, presented by Dr Alex Pitcher (Oxford University Hospitals NHS Foundation Trust, UK), posing 3 research questions [1]:
- Treatment with ARBs versus placebo or control;
- Treatment with ARBs versus beta-blockers;
- Indirectly, treatment with beta-blockers versus placebo or control.
Individual data in Marfan patients with no prior aortic surgery was pooled from 7 randomised trials (n=1,442) for these analyses. Firstly, with a median follow-up of 3 years, the researchers noted that treatment with ARBs versus placebo or open control (n=676; average age 29 years, 83% with confirmed pathogenic FBN1 variant; 75% taking beta-blocker at baseline), treatment with ARBs reduced the annual increase of rate of change in the aortic root Z-score to an absolute difference of -0.07 (95% CI -0.12 to -0.01; P=0.012). Aortic dimensions were likewise decreased.
Dr Pitcher paused to summarise this part of the data: “The benefit of ARB therapy was particularly large in patients with an FBN1 mutation at baseline, making it more plausible that the effect is real. There were no other detectable differences in treatment effect depending on other patient characteristics, including age, sex, and blood pressure. The benefit of ARB treatment was similar regardless of whether patients were taking a beta-blocker.”
Secondly, comparing an ARB with a beta-blocker (n=766 patients; average age 14 years; 86% with confirmed pathogenic FBN1 variant; 0% taking beta-blocker at baseline) with a 3-year follow-up, the annual change in the aortic root Z-score was similar in the 2 groups (absolute difference 0.03; 95% CI -0.05 to 0.10, not significant).
Thirdly, indirect evaluation of the effect of a beta-blocker compared with placebo/control suggested that being randomised to a beta-blocker approximately halved the annual change in the aortic root Z-score (absolute difference -0.09; 95% CI -0.18 to -0.0033; P=0.04). The researchers concluded that both treatment with ARBs or beta-blockers has clinical benefit, and because these effects are independent, dual therapy may provide an additive benefit to delay aortic root surgery.
- Pitcher A, et al. MTT - Assessing the effects of ARBs and beta-blockers in Marfan Syndrome. Hot Line Session 9, ESC Congress 2022, Barcelona, Spain, 26–29 August.
Copyright ©2022 Medicom Medical Publishers
Posted on
Previous Article
« ENTRIGUE: Subcutaneous pegozafermin in severe hypertriglyceridaemia Next Article
Long-term therapy with evolocumab associated with lower CV mortality »
« ENTRIGUE: Subcutaneous pegozafermin in severe hypertriglyceridaemia Next Article
Long-term therapy with evolocumab associated with lower CV mortality »
Table of Contents: ESC 2022
Featured articles
ESC Clinical Practice Guidelines
Prevention of VT and sudden cardiac death: the new recommendations
New and first ESC cardio-oncology guideline
The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension
Cardiovascular assessment and management of patients undergoing non-cardiac surgery
Heart Failure
Old dogs, new tricks: Acetazolamide plus loop diuretics improves decongestion
No effect of neprilysin inhibition on cognition
Dapagliflozin DELIVERs for HFmrEF/HFpEF
Meta-analysis of DELIVER and EMPEROR-Preserved
Anticoagulation
Rheumatic heart disease-associated AF: standard-of-care holds ground
New anticoagulant safe and maybe effective: PACIFIC-AMI and PACIFIC-Stroke outcomes
AXIOMATIC-SSP: Reducing risk of ischaemic stroke with factor XIa inhibition?
Evolving evidence for P2Y12 inhibition in chronic coronary syndromes: PANTHER
Prevention
Danish study suggests starting CVD screening before age 70
Polypill SECUREs win in secondary prevention in elderly
Long-term therapy with evolocumab associated with lower CV mortality
ARBs + beta-blockers may delay Marfan syndrome aortic root replacement
ENTRIGUE: Subcutaneous pegozafermin in severe hypertriglyceridaemia
Artificial Intelligence & Digital Health – What Is New
First RCT evidence for use of AI in daily practice
AI-enhanced echography supports aortic stenosis patients
Ischaemia
Medical therapy versus PCI for ischaemic cardiomyopathy
Allopurinol disappoints in ALL-HEART
Conservative or invasive management for high-risk kidney disease patients with ischaemia?
Genotype-guided antiplatelet therapy in patients receiving PCI
Other HOTLINE Sessions
BOXing out oxygen and blood pressure targets
Coronary CT angiography diagnostics compared head-to-head
High-dose influenza vaccine: mortality benefit?
FFR-guided decision-making in patients with AMI and multivessel disease
Related Articles
October 27, 2022
Allopurinol disappoints in ALL-HEART

October 27, 2022
First RCT evidence for use of AI in daily practice
October 27, 2022
Meta-analysis of DELIVER and EMPEROR-Preserved
© 2024 Medicom Medical Publishers. All rights reserved. Terms and Conditions | Privacy Policy
HEAD OFFICE
Laarderhoogtweg 25
1101 EB Amsterdam
The Netherlands
T: +31 85 4012 560
E: publishers@medicom-publishers.com