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 journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)380-385
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume36
Issue number4
DOIs
StatePublished - Apr 1 2017

Keywords

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

ASJC Scopus subject areas

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

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