Gender differences in angiotensin II and aldosterone secretion in patients with pressure overloaded systemic right ventricles are similar to those observed in systemic arterial hypertension.

BACKGROUND

There are very few and inconclusive data concerning the renin-angiotensin-aldosterone system activity in adults with systemic right ventricles, compared to classic heart failure patients. Therefore, we prospectively evaluated angiotensin II and aldosterone levels in a series of patients following Mustard or Senning procedures for complete transposition of the great arteries.

METHODS

Forty-two patients (31 male and 11 female, mean age 20.8 ± 3.7 years), 18.2 ± 2.8 years following atrial switch procedures, were included in the analysis. All the patients underwent comprehensive echocardiographic examinations. Angiotensin II and aldosterone levels were measured with immunoradiometric assays.

RESULTS

The mean angiotensin II level was 11.9 ± 9.4 pg/mL; 15 patients (35.7%) had angiotensin II levels exceeding the upper limit of normal values. There was a negative correlation between angiotensin II levels and treatment with angiotensin enzyme inhibitors (r = -0.33, P = 0.03). The mean aldosterone level was 217.7 ± 160.2 pg/mL; 26 patients (61.9%) had aldosterone levels exceeding the upper limit of normal values. Female patients had significantly higher aldosterone levels than male patients (321 ± 248 vs 180 ± 95 pg/mL, P = 0.01). A negative correlation between angiotensin II levels and fractional area change (r = -0.65, P=0.03), and a positive correlation between aldosterone levels and right ventricular end-diastolic area (r = 0.66, P = 0.03) were observed in female but not in male patients.

CONCLUSIONS

Renin-angiotensin-aldosterone axis activation in patients with systemic right ventricles was similar to reported values in other studies of stable heart failure. The gender differences in aldosterone levels in patients with systemic right ventricles were similar to that associated with left ventricular remodeling in systemic arterial hypertension.