Author + information
- Sebastian Herrmann, MD⁎ ( and )
- Frank Weidemann, MD
- ↵⁎Medizinische Klinik und Poliklinik I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
We appreciate the interest of Dr. Jao and colleagues in our study “Low-Gradient Aortic Valve Stenosis: Myocardial Fibrosis and Its Influence on Function and Outcome” (1). We fully agree that angiotensin-converting enzyme (ACE) inhibitors have an impact on hemodynamics and probably also on prognosis in patients with aortic stenosis. Thus, we want to provide the information that both ACE inhibitors and aldosterone antagonists were homogenously distributed within the different groups.
However, the aim of our study was not to analyze the impact of pharmacological therapy on hemodynamics and prognosis in patients with aortic stenosis, which can only be done in larger prospective cohort studies. Rather, we tried to describe in detail the typical morphology, function, and hemodynamics of patients with a low-gradient aortic stenosis. In this respect, we analyzed the systemic vascular resistance and the valvuloarterial impedance, which should both reflect the impact of an ACE inhibitor therapy and other blood pressure–lowering medications.
In addition, we agree, due to our own experience, that patients with aortic stenosis can be treated with ACE inhibitors and that this pharmacological therapy can both prevent progression of the disease in earlier stages and reduces cardio vascular events in later stages (2,3). However, at the right time, there has to be a causal therapy like aortic valve replacement to avoid the progress towards myocardial fibrosis and to ameliorate long-term prognosis and cardiac remodeling.
- American College of Cardiology Foundation
- Herrmann S.,
- Stork S.,
- Nieman M.,
- et al.
- Adnan Nadir M.,
- Wie L.,
- Douglas H.J.,
- et al.