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

Brian A. Houston, Andrea L C Schneider, Joban Vaishnav, David M. Cromwell, P. Elliott Miller, Kamil F. Faridi, Ashish Shah, Chris Sciortino, Glenn Whitman, Ryan J. Tedford, Gerin R. Stevens, Daniel P. Judge, Stuart D. Russell, Rosanne Rouf

Research output: Contribution to journalArticle

Abstract

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.

LanguageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart-Assist Devices
Arteriovenous Malformations
Angiotensin II
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Hemorrhage
Logistic Models
Odds Ratio
Angiopoietin-2
Confidence Intervals
Therapeutics
International Normalized Ratio
Cardiomyopathies
Proportional Hazards Models
Vascular Endothelial Growth Factor A
Regression Analysis
Demography
Blood Pressure
Kidney

Keywords

  • ACE inhibitor
  • ARB
  • Arteriovenous malformations
  • GI bleed
  • LVAD

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. / Houston, Brian A.; Schneider, Andrea L C; Vaishnav, Joban; Cromwell, David M.; Miller, P. Elliott; Faridi, Kamil F.; Shah, Ashish; Sciortino, Chris; Whitman, Glenn; Tedford, Ryan J.; Stevens, Gerin R.; Judge, Daniel P.; Russell, Stuart D.; Rouf, Rosanne.

In: Journal of Heart and Lung Transplantation, 2017.

Research output: Contribution to journalArticle

Houston, Brian A. ; Schneider, Andrea L C ; Vaishnav, Joban ; Cromwell, David M. ; Miller, P. Elliott ; Faridi, Kamil F. ; Shah, Ashish ; Sciortino, Chris ; Whitman, Glenn ; Tedford, Ryan J. ; Stevens, Gerin R. ; Judge, Daniel P. ; Russell, Stuart D. ; Rouf, Rosanne. / Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. In: Journal of Heart and Lung Transplantation. 2017
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abstract = "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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AU - Houston,Brian A.

AU - Schneider,Andrea L C

AU - Vaishnav,Joban

AU - Cromwell,David M.

AU - Miller,P. Elliott

AU - Faridi,Kamil F.

AU - Shah,Ashish

AU - Sciortino,Chris

AU - Whitman,Glenn

AU - Tedford,Ryan J.

AU - Stevens,Gerin R.

AU - Judge,Daniel P.

AU - Russell,Stuart D.

AU - Rouf,Rosanne

PY - 2017

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N2 - 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.

AB - 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.

KW - ACE inhibitor

KW - ARB

KW - Arteriovenous malformations

KW - GI bleed

KW - LVAD

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