Effect of Losartan on Right Ventricular Dysfunction: Results From the Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone System) in Adults With Repaired Tetralogy of Fallot
BACKGROUND:The effect of angiotensin II receptor blockers on right ventricular (RV) function is still unknown. Angiotensin II receptor blockers are beneficial in patients with acquired left ventricular dysfunction, and recent findings have suggested a favorable effect in symptomatic patients with sy...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2018-04, Vol.137 (14), p.1463-1471 |
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| creator | Bokma, Jouke P Winter, Michiel M van Dijk, Arie P Vliegen, Hubert W van Melle, Joost P Meijboom, Folkert J Post, Martijn C Berbee, Jacqueline K Boekholdt, S Matthijs Groenink, Maarten Zwinderman, Aeilko H Mulder, Barbara J.M Bouma, Berto J |
| description | BACKGROUND:The effect of angiotensin II receptor blockers on right ventricular (RV) function is still unknown. Angiotensin II receptor blockers are beneficial in patients with acquired left ventricular dysfunction, and recent findings have suggested a favorable effect in symptomatic patients with systemic RV dysfunction. The current study aimed to determine the effect of losartan, an angiotensin II receptor blocker, on subpulmonary RV dysfunction in adults after repaired tetralogy of Fallot.
METHODS:The REDEFINE trial (Right Ventricular Dysfunction in Tetralogy of FallotInhibition of the Renin-Angiotensin-Aldosterone System) is an investigator-initiated, multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled study. Adults with repaired tetralogy of Fallot and RV dysfunction (RV ejection fraction [EF] 0.30 for all). In predefined subgroup analyses, losartan did not have a statistically significant impact on RV EF in subgroups with symptoms, restrictive RV, RV EF |
| doi_str_mv | 10.1161/CIRCULATIONAHA.117.031438 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1975030488</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1975030488</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3067-4b8699652e3b6056d329f593aded7495617ffd9b6c51c230a50766d8cb3cb473</originalsourceid><addsrcrecordid>eNp9Ul9v0zAcDAhEy-ArIPM2pGXYcRLHewv9wypVmxQKPEZO7DQGx-5sR1P36XHWgYSEePLPp7v7neyLovcIXiKUo4-LTbX4ui13m9ub8roMGLmEGKW4eB7NUZakcZph-iKaQwhpTHCSzKLXzv0I1xyT7FU0S2iSJAjT-bPZqutE64HpwNY4Zj3TwGhQyX3vwTehvZXtqJgFy6PrRt16afQVqIQblXdgbc0AfC_A0oyNEvEnJTW_ABXT3AzyQXBQrZar9eZmBXZWMgXO_2sMpAY74S1TZn-cIq2ZUsZfgY3uZSMfKQGdFlZCSx2Xei-NF9pNs-LGeWGNFuDLMUzDh8mv5I9Jv0vfB9GBSRtS_WPJm-hlx5QTb5_Os2i3Xu0W1_H29vNmUW7jFsOcxGlT5JTmWSJwk8Ms5zihXUYx44KTlGY5Il3HaZO3GWoTDFkGSZ7zom1w26QEn0XnJ9uDNXejcL4epGuFUkwLM7oaUZJBDNOiCFR6orbWOGdFVx-sHJg91gjWUw_qv3sQMFKfehC0757WjM0g-B_l748PhPREuDcqPJr7qcZ7YeteMOX7OjQlhEAkTiAqYBrmeIII_gWRScNS</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1975030488</pqid></control><display><type>article</type><title>Effect of Losartan on Right Ventricular Dysfunction: Results From the Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone System) in Adults With Repaired Tetralogy of Fallot</title><source>Journals@Ovid Ovid Autoload</source><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Bokma, Jouke P ; Winter, Michiel M ; van Dijk, Arie P ; Vliegen, Hubert W ; van Melle, Joost P ; Meijboom, Folkert J ; Post, Martijn C ; Berbee, Jacqueline K ; Boekholdt, S Matthijs ; Groenink, Maarten ; Zwinderman, Aeilko H ; Mulder, Barbara J.M ; Bouma, Berto J</creator><creatorcontrib>Bokma, Jouke P ; Winter, Michiel M ; van Dijk, Arie P ; Vliegen, Hubert W ; van Melle, Joost P ; Meijboom, Folkert J ; Post, Martijn C ; Berbee, Jacqueline K ; Boekholdt, S Matthijs ; Groenink, Maarten ; Zwinderman, Aeilko H ; Mulder, Barbara J.M ; Bouma, Berto J</creatorcontrib><description>BACKGROUND:The effect of angiotensin II receptor blockers on right ventricular (RV) function is still unknown. Angiotensin II receptor blockers are beneficial in patients with acquired left ventricular dysfunction, and recent findings have suggested a favorable effect in symptomatic patients with systemic RV dysfunction. The current study aimed to determine the effect of losartan, an angiotensin II receptor blocker, on subpulmonary RV dysfunction in adults after repaired tetralogy of Fallot.
METHODS:The REDEFINE trial (Right Ventricular Dysfunction in Tetralogy of FallotInhibition of the Renin-Angiotensin-Aldosterone System) is an investigator-initiated, multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled study. Adults with repaired tetralogy of Fallot and RV dysfunction (RV ejection fraction [EF] <50%) but without severe valvular dysfunction were eligible. Patients were randomly assigned between losartan (150 mg daily) and placebo with target treatment duration between 18 and 24 months. The primary outcome was RV EF change, determined by cardiovascular MRI in intention-to-treat analysis.
RESULTS:Of 95 included patients, 47 patients received 150 mg losartan daily (age, 38.0±12.4 years; 74% male), and 48 patients received placebo (age, 40.6±11.4 years; 63% male). Overall, RV EF did not change in patients allocated to losartan (n=42) (44.4±5.1% to 45.2±5.0%) and placebo (n=46) (43.2±6.3% to 43.6±6.9%). Losartan did not significantly improve RV EF in comparison with placebo (+0.51%; 95% confidence interval, –1.0 to +2.0; P=0.50). No significant treatment effects were found on secondary outcomesleft ventricular EF, peak aerobic exercise capacity, and N-terminal pro–brain natriuretic peptide (P>0.30 for all). In predefined subgroup analyses, losartan did not have a statistically significant impact on RV EF in subgroups with symptoms, restrictive RV, RV EF<40%, pulmonary valve replacement, or QRS fragmentation. However, in a post hoc analysis, losartan was associated with improved RV EF in a subgroup (n=30) with nonrestrictive RV and incomplete remodeling (QRS fragmentation and previous pulmonary valve replacement) (+2.7%; 95% confidence interval, +0.1 to +5.4; P=0.045).
CONCLUSIONS:Losartan had no significant effect on RV dysfunction or secondary outcome parameters in repaired tetralogy of Fallot. Future larger studies may determine whether there might be a role for losartan in specific vulnerable subgroups.
CLINICAL TRIAL REGISTRATION:URLhttps://www.clinicaltrials.gov. Unique identifierNCT02010905.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.117.031438</identifier><identifier>PMID: 29222139</identifier><language>eng</language><publisher>United States: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>Adult ; Atrial Natriuretic Factor - analysis ; Blood Pressure ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Losartan - adverse effects ; Losartan - therapeutic use ; Male ; Middle Aged ; Placebo Effect ; Prospective Studies ; Protein Precursors - analysis ; Tetralogy of Fallot - drug therapy ; Tetralogy of Fallot - pathology ; Treatment Outcome ; Ventricular Dysfunction, Right - drug therapy ; Ventricular Dysfunction, Right - pathology</subject><ispartof>Circulation (New York, N.Y.), 2018-04, Vol.137 (14), p.1463-1471</ispartof><rights>2018 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><rights>2017 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3067-4b8699652e3b6056d329f593aded7495617ffd9b6c51c230a50766d8cb3cb473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29222139$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bokma, Jouke P</creatorcontrib><creatorcontrib>Winter, Michiel M</creatorcontrib><creatorcontrib>van Dijk, Arie P</creatorcontrib><creatorcontrib>Vliegen, Hubert W</creatorcontrib><creatorcontrib>van Melle, Joost P</creatorcontrib><creatorcontrib>Meijboom, Folkert J</creatorcontrib><creatorcontrib>Post, Martijn C</creatorcontrib><creatorcontrib>Berbee, Jacqueline K</creatorcontrib><creatorcontrib>Boekholdt, S Matthijs</creatorcontrib><creatorcontrib>Groenink, Maarten</creatorcontrib><creatorcontrib>Zwinderman, Aeilko H</creatorcontrib><creatorcontrib>Mulder, Barbara J.M</creatorcontrib><creatorcontrib>Bouma, Berto J</creatorcontrib><title>Effect of Losartan on Right Ventricular Dysfunction: Results From the Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone System) in Adults With Repaired Tetralogy of Fallot</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>BACKGROUND:The effect of angiotensin II receptor blockers on right ventricular (RV) function is still unknown. Angiotensin II receptor blockers are beneficial in patients with acquired left ventricular dysfunction, and recent findings have suggested a favorable effect in symptomatic patients with systemic RV dysfunction. The current study aimed to determine the effect of losartan, an angiotensin II receptor blocker, on subpulmonary RV dysfunction in adults after repaired tetralogy of Fallot.
METHODS:The REDEFINE trial (Right Ventricular Dysfunction in Tetralogy of FallotInhibition of the Renin-Angiotensin-Aldosterone System) is an investigator-initiated, multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled study. Adults with repaired tetralogy of Fallot and RV dysfunction (RV ejection fraction [EF] <50%) but without severe valvular dysfunction were eligible. Patients were randomly assigned between losartan (150 mg daily) and placebo with target treatment duration between 18 and 24 months. The primary outcome was RV EF change, determined by cardiovascular MRI in intention-to-treat analysis.
RESULTS:Of 95 included patients, 47 patients received 150 mg losartan daily (age, 38.0±12.4 years; 74% male), and 48 patients received placebo (age, 40.6±11.4 years; 63% male). Overall, RV EF did not change in patients allocated to losartan (n=42) (44.4±5.1% to 45.2±5.0%) and placebo (n=46) (43.2±6.3% to 43.6±6.9%). Losartan did not significantly improve RV EF in comparison with placebo (+0.51%; 95% confidence interval, –1.0 to +2.0; P=0.50). No significant treatment effects were found on secondary outcomesleft ventricular EF, peak aerobic exercise capacity, and N-terminal pro–brain natriuretic peptide (P>0.30 for all). In predefined subgroup analyses, losartan did not have a statistically significant impact on RV EF in subgroups with symptoms, restrictive RV, RV EF<40%, pulmonary valve replacement, or QRS fragmentation. However, in a post hoc analysis, losartan was associated with improved RV EF in a subgroup (n=30) with nonrestrictive RV and incomplete remodeling (QRS fragmentation and previous pulmonary valve replacement) (+2.7%; 95% confidence interval, +0.1 to +5.4; P=0.045).
CONCLUSIONS:Losartan had no significant effect on RV dysfunction or secondary outcome parameters in repaired tetralogy of Fallot. Future larger studies may determine whether there might be a role for losartan in specific vulnerable subgroups.
CLINICAL TRIAL REGISTRATION:URLhttps://www.clinicaltrials.gov. Unique identifierNCT02010905.</description><subject>Adult</subject><subject>Atrial Natriuretic Factor - analysis</subject><subject>Blood Pressure</subject><subject>Double-Blind Method</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Humans</subject><subject>Losartan - adverse effects</subject><subject>Losartan - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Placebo Effect</subject><subject>Prospective Studies</subject><subject>Protein Precursors - analysis</subject><subject>Tetralogy of Fallot - drug therapy</subject><subject>Tetralogy of Fallot - pathology</subject><subject>Treatment Outcome</subject><subject>Ventricular Dysfunction, Right - drug therapy</subject><subject>Ventricular Dysfunction, Right - pathology</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Ul9v0zAcDAhEy-ArIPM2pGXYcRLHewv9wypVmxQKPEZO7DQGx-5sR1P36XHWgYSEePLPp7v7neyLovcIXiKUo4-LTbX4ui13m9ub8roMGLmEGKW4eB7NUZakcZph-iKaQwhpTHCSzKLXzv0I1xyT7FU0S2iSJAjT-bPZqutE64HpwNY4Zj3TwGhQyX3vwTehvZXtqJgFy6PrRt16afQVqIQblXdgbc0AfC_A0oyNEvEnJTW_ABXT3AzyQXBQrZar9eZmBXZWMgXO_2sMpAY74S1TZn-cIq2ZUsZfgY3uZSMfKQGdFlZCSx2Xei-NF9pNs-LGeWGNFuDLMUzDh8mv5I9Jv0vfB9GBSRtS_WPJm-hlx5QTb5_Os2i3Xu0W1_H29vNmUW7jFsOcxGlT5JTmWSJwk8Ms5zihXUYx44KTlGY5Il3HaZO3GWoTDFkGSZ7zom1w26QEn0XnJ9uDNXejcL4epGuFUkwLM7oaUZJBDNOiCFR6orbWOGdFVx-sHJg91gjWUw_qv3sQMFKfehC0757WjM0g-B_l748PhPREuDcqPJr7qcZ7YeteMOX7OjQlhEAkTiAqYBrmeIII_gWRScNS</recordid><startdate>20180403</startdate><enddate>20180403</enddate><creator>Bokma, Jouke P</creator><creator>Winter, Michiel M</creator><creator>van Dijk, Arie P</creator><creator>Vliegen, Hubert W</creator><creator>van Melle, Joost P</creator><creator>Meijboom, Folkert J</creator><creator>Post, Martijn C</creator><creator>Berbee, Jacqueline K</creator><creator>Boekholdt, S Matthijs</creator><creator>Groenink, Maarten</creator><creator>Zwinderman, Aeilko H</creator><creator>Mulder, Barbara J.M</creator><creator>Bouma, Berto J</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20180403</creationdate><title>Effect of Losartan on Right Ventricular Dysfunction: Results From the Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone System) in Adults With Repaired Tetralogy of Fallot</title><author>Bokma, Jouke P ; Winter, Michiel M ; van Dijk, Arie P ; Vliegen, Hubert W ; van Melle, Joost P ; Meijboom, Folkert J ; Post, Martijn C ; Berbee, Jacqueline K ; Boekholdt, S Matthijs ; Groenink, Maarten ; Zwinderman, Aeilko H ; Mulder, Barbara J.M ; Bouma, Berto J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3067-4b8699652e3b6056d329f593aded7495617ffd9b6c51c230a50766d8cb3cb473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Atrial Natriuretic Factor - analysis</topic><topic>Blood Pressure</topic><topic>Double-Blind Method</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Humans</topic><topic>Losartan - adverse effects</topic><topic>Losartan - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Placebo Effect</topic><topic>Prospective Studies</topic><topic>Protein Precursors - analysis</topic><topic>Tetralogy of Fallot - drug therapy</topic><topic>Tetralogy of Fallot - pathology</topic><topic>Treatment Outcome</topic><topic>Ventricular Dysfunction, Right - drug therapy</topic><topic>Ventricular Dysfunction, Right - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bokma, Jouke P</creatorcontrib><creatorcontrib>Winter, Michiel M</creatorcontrib><creatorcontrib>van Dijk, Arie P</creatorcontrib><creatorcontrib>Vliegen, Hubert W</creatorcontrib><creatorcontrib>van Melle, Joost P</creatorcontrib><creatorcontrib>Meijboom, Folkert J</creatorcontrib><creatorcontrib>Post, Martijn C</creatorcontrib><creatorcontrib>Berbee, Jacqueline K</creatorcontrib><creatorcontrib>Boekholdt, S Matthijs</creatorcontrib><creatorcontrib>Groenink, Maarten</creatorcontrib><creatorcontrib>Zwinderman, Aeilko H</creatorcontrib><creatorcontrib>Mulder, Barbara J.M</creatorcontrib><creatorcontrib>Bouma, Berto J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bokma, Jouke P</au><au>Winter, Michiel M</au><au>van Dijk, Arie P</au><au>Vliegen, Hubert W</au><au>van Melle, Joost P</au><au>Meijboom, Folkert J</au><au>Post, Martijn C</au><au>Berbee, Jacqueline K</au><au>Boekholdt, S Matthijs</au><au>Groenink, Maarten</au><au>Zwinderman, Aeilko H</au><au>Mulder, Barbara J.M</au><au>Bouma, Berto J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Losartan on Right Ventricular Dysfunction: Results From the Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone System) in Adults With Repaired Tetralogy of Fallot</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2018-04-03</date><risdate>2018</risdate><volume>137</volume><issue>14</issue><spage>1463</spage><epage>1471</epage><pages>1463-1471</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>BACKGROUND:The effect of angiotensin II receptor blockers on right ventricular (RV) function is still unknown. Angiotensin II receptor blockers are beneficial in patients with acquired left ventricular dysfunction, and recent findings have suggested a favorable effect in symptomatic patients with systemic RV dysfunction. The current study aimed to determine the effect of losartan, an angiotensin II receptor blocker, on subpulmonary RV dysfunction in adults after repaired tetralogy of Fallot.
METHODS:The REDEFINE trial (Right Ventricular Dysfunction in Tetralogy of FallotInhibition of the Renin-Angiotensin-Aldosterone System) is an investigator-initiated, multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled study. Adults with repaired tetralogy of Fallot and RV dysfunction (RV ejection fraction [EF] <50%) but without severe valvular dysfunction were eligible. Patients were randomly assigned between losartan (150 mg daily) and placebo with target treatment duration between 18 and 24 months. The primary outcome was RV EF change, determined by cardiovascular MRI in intention-to-treat analysis.
RESULTS:Of 95 included patients, 47 patients received 150 mg losartan daily (age, 38.0±12.4 years; 74% male), and 48 patients received placebo (age, 40.6±11.4 years; 63% male). Overall, RV EF did not change in patients allocated to losartan (n=42) (44.4±5.1% to 45.2±5.0%) and placebo (n=46) (43.2±6.3% to 43.6±6.9%). Losartan did not significantly improve RV EF in comparison with placebo (+0.51%; 95% confidence interval, –1.0 to +2.0; P=0.50). No significant treatment effects were found on secondary outcomesleft ventricular EF, peak aerobic exercise capacity, and N-terminal pro–brain natriuretic peptide (P>0.30 for all). In predefined subgroup analyses, losartan did not have a statistically significant impact on RV EF in subgroups with symptoms, restrictive RV, RV EF<40%, pulmonary valve replacement, or QRS fragmentation. However, in a post hoc analysis, losartan was associated with improved RV EF in a subgroup (n=30) with nonrestrictive RV and incomplete remodeling (QRS fragmentation and previous pulmonary valve replacement) (+2.7%; 95% confidence interval, +0.1 to +5.4; P=0.045).
CONCLUSIONS:Losartan had no significant effect on RV dysfunction or secondary outcome parameters in repaired tetralogy of Fallot. Future larger studies may determine whether there might be a role for losartan in specific vulnerable subgroups.
CLINICAL TRIAL REGISTRATION:URLhttps://www.clinicaltrials.gov. Unique identifierNCT02010905.</abstract><cop>United States</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>29222139</pmid><doi>10.1161/CIRCULATIONAHA.117.031438</doi><tpages>9</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2018-04, Vol.137 (14), p.1463-1471 |
| issn | 0009-7322 1524-4539 |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Atrial Natriuretic Factor - analysis Blood Pressure Double-Blind Method Drug Administration Schedule Female Humans Losartan - adverse effects Losartan - therapeutic use Male Middle Aged Placebo Effect Prospective Studies Protein Precursors - analysis Tetralogy of Fallot - drug therapy Tetralogy of Fallot - pathology Treatment Outcome Ventricular Dysfunction, Right - drug therapy Ventricular Dysfunction, Right - pathology |
| title | Effect of Losartan on Right Ventricular Dysfunction: Results From the Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone System) in Adults With Repaired Tetralogy of Fallot |
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