Retrospective analysis of the prognostic effect of angiotensin receptor blocker on non-Marfan aortic dissection

Background Aortic dissection(AD)is a life-threatening vascular disease caused by various etiologies including Marfan’s syndrome.Angiotensin receptor blocker(ARB)drugs have been confirmed beneficial for patients with Marfanoid AD but remain unclear for non-Marfanoid case.Methods Patients with DeBakey typeⅢ,Standford A aortic dissection were consecutively recruited to Guangdong Provincial People’s Hospital and Jieyang People’s Hospital between January 2010 and January 2015,with 25 individuals in the ARB group and 32 individuals in the non-ARB group(control group),respectively.The follow-up was performed by database or telephone.The follow-up data consisted of patient’s symptoms and chief complaints,blood pressure,heart rate,and aortic computed tomography angiography(CTA)data.Endpoints and in-hospital events were recorded.Results Baseline data,including age,gender,heart rate,smoking status,and the incidence of diabetes,demonstrated no significant difference between two groups.There was neither death nor urgent surgical case in either group during the follow-up period.The aortic CTA follow-up demonstrated the absorption of the proximal inversely avulsed hematoma for both groups,whereas the reduction was more evident in the ARB group as compared with the non-ARB group[-(9.33±1.99)mm vs.-(4.08±2.35)mm,respectively,P<0.05],suggesting that hematoma absorption was more remarkable in the ARB group.The maximum vascular diameter at the dissection in both groups declined during the follow-up,whereas the reduction in the ARB group was significantly more striking relative to that in the non-ARB group[-(5.50±1.15)mm vs.-(0.31±0.69)mm,respectively,P<0.001],indicating a potential role of ARB drugs in curbing aortic enlargement and remodeling.Conclusions Independent of blood pressure(BP)reduction,ARB utilization in patients with non-Marfan’s aortic dissection may facilitate the absorption of reverse-torn hematoma at the proximal end of dissection,as well as delaying the aortic dilation and remodeling.