Angiotensin-Converting Enzyme Genetic Polymorphism: Its Impact on Cardiac Remodeling

Abstract

BackgroundThe role of angiotensin-converting enzyme genetic polymorphisms as a predictor of echocardiographic outcomes on heart failure is yet to be established. The local profile should be identified so that the impact of those genotypes on the Brazilian population could be identified. This is the first study on exclusively non-ischemic heart failure over a follow-up longer than 5 years. ObjectiveTo determine the distribution of angiotensin-converting enzyme genetic polymorphism variants and their relation with echocardiographic outcome of patients with non-ischemic heart failure. MethodsSecondary analysis of the medical records of 111 patients and identification of the angiotensin-converting enzyme genetic polymorphism variants, classified as DD (Deletion/Deletion), DI (Deletion/Insertion) or II (Insertion/Insertion). ResultsThe cohort means were as follows: follow-up, 64.9 months; age, 59.5 years; male sex, 60.4%; white skin color, 51.4%; use of beta-blockers, 98.2%; and use of angiotensin-converting-enzyme inhibitors or angiotensin receptor blocker, 89.2%. The angiotensin-converting enzyme genetic polymorphism distribution was as follows: DD, 51.4%; DI, 44.1%; and II, 4.5%. No difference regarding the clinical characteristics or treatment was observed between the groups. The final left ventricular systolic diameter was the only isolated echocardiographic variable that significantly differed between the angiotensin-converting enzyme genetic polymorphisms: 59.2 ± 1.8 for DD versus 52.3 ± 1.9 for DI versus 59.2 ± 5.2 for II (p = 0.029). Considering the evolutionary behavior, all echocardiographic variables (difference between the left ventricular ejection fraction at the last and first consultation; difference between the left ventricular systolic diameter at the last and first consultation; and difference between the left ventricular diastolic diameter at the last and first consultation) differed between the genotypes (p = 0.024; p = 0.002; and p = 0.021, respectively). ConclusionThe distribution of the angiotensin-converting enzyme genetic polymorphisms differed from that of other studies with a very small number of II. The DD genotype was independently associated with worse echocardiographic outcome, while the DI genotype, with the best echocardiographic profile (increased left ventricular ejection fraction and decreased left ventricular diameters).

Angiotensin-Converting Enzyme ID Polymorphism in Patients with Heart Failure Secondary to Chagas Disease

“…An independent association has been reported between DD genotype and worse echocardiographic outcomes, and between ID genotype and echocardiographic profile (increased left ventricular ejection fraction and decreased left ventricular diameters). 19 These findings are in disagreement with ours, as we did not find an association between D/I genotypes and echocardiographic findings.…”

Angiotensin-converting enzyme insertion/deletion polymorphism, 24-h blood pressure profile and left ventricular hypertrophy in hypertensive individuals: a cross-sectional study

“…In favor of this hypothesis, the results of a meta-analysis found a greater risk for LVH associated with the D allele or DD genotype in untreated hypertensive patients [ 20 ]. In addition, DD genotype was also independently associated with worse echocardiographic outcome in patients with non-ischemic heart failure [ 55 ]. This is related to an increased neurohormonal response, mainly of the renin–angiotensin aldosterone system [ 56 ].…”

Analysis of the arterial pressure daily profle characteristics effect on structural and functional heart state in patients with arterial hypertension stage II, depending on the Angiotensin-Converting Enzyme gene I/D polymorphism

“…Водночас генотип ІІ може призводити до ГЛШ і, таким чином, до розвитку діастолічної дисфункції. У дослідженні De Albuquerque F. N. при аналізі розподілу I/D поліморфізму гена АПФ у хворих із серцевою недостатністю встановив низьку частоту генотипу ІІ і переважання генотипу DD, при цьому пацієнти з генотипом ІD характеризувалися кращим ехокардіографічним профілем [7]. У хворих з АГ і серцевою недостатністю зі збереженою фракцією викиду лівого шлуночка D-алелі асоціювались зі значною ГЛШ [8].…”