BACKGROUND: Patients with systemic right ventricle (SRV), either d-transposition of the great arteries following an atrial switch procedure or congenitally corrected transposition of the great arteries, develop severe right ventricular dysfunction, prompting appropriate medical therapy. However, the efficacy of beta-blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in SRV patients is unproven. OBJECTIVES: The objective of this study was to determine the effects of ACEI/ARB and beta-blockers on outcomes in SRV patients after accounting for likely cofounders affecting their use. METHODS: From a retrospective, multicenter study on heart failure-related outcome in individuals with SRV, those who were taking an ACEI/ARB, beta-blocker, or both of these medication were identified. We performed a propensity analysis to match them to those not using these medications at their initial visit. Matching was based on a propensity score, which captured co-morbidities, demographics, and baseline echocardiographic parameters. Primary outcome of death, transplant, or mechanical circulatory support, and secondary outcomes of heart failure hospitalizations/atrial arrhythmias were analyzed respectively. RESULTS: We identified 393 patients taking ACEI/ARB or beta-blocker, or taking both a beta-blocker and ACEI/ARB (62.1% male, median age 31.3 years) and 484 patients (56.4% male, median age of 26.0 years) who were neither on a beta-blocker nor on ACEI/ARB at the time of initial clinic visit. Median follow-up was ∼8 years. After propensity matching, medication use was not associated with decreased mortality, heart failure hospitalizations, or arrhythmias. Hazard ratios remained positive for beta blockers, implying potential harm rather than benefit. CONCLUSIONS: In this large multicenter propensity-matched observational study, patients with SRV taking beta-blockers or ACEI/ARB did not have a benefit in survival or reduced hospitalization. The likelihood of demonstrating favorable effects in larger studies appears remote.

Adult Congenital Heart Disease Unit Hospital Universitario Virgen Del Rocio Sevilla Spain

Adult Congenital Heart Disease Unit Monaldi Hospital Napoli Italy

Boston Children's Hospital and Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA

Boston Children's Hospital Harvard Medical School Boston Massachusetts USA

Children's Hospital Omaha and University of Nebraska Medical Center Omaha Nebraska USA

Cincinnati Children's Hospital Medical Center Heart Institute Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA

Colorado Adult and Teen Congenital Heart Program Colorado University School of Medicine Denver Colorado USA

Department of Cardiology Erasmus Medical Center Rotterdam the Netherlands

Department of Cardiology Regina General Hospital Regina Saskatchewan Canada

Department of Cardiology University of Mississippi Medical Center Jackson Mississippi USA

Department of Cardiology University of Sydney and Royal Prince Alfred Hospital Sydney Australia

Department of Cardiovascular Surgery 2nd Faculty of Medicine University Hospital Motol Prague Czech Republic

Department of Medicine Montreal Heart Institute Montreal Heart Institute Montreal Quebec Canada

Department of Medicine Royal Melbourne Hospital Melbourne Australia

Division of Cardiology Amsterdam University Medical Center Amsterdam the Netherlands

Division of Cardiology Children's Hospital of Wisconsin Milwaukee Wisconsin USA

Division of Cardiology Department of Medicine Ahmanson UCLA Adult Congenital Heart Disease Center UCLA Medical Center Los Angeles California USA

Division of Cardiology Department of Medicine Emory University Hospital Atlanta Georgia USA

Division of Cardiology Krannert Institute of Cardiology Indianapolis Indiana USA

Division of Cardiology Saint Luke's Mid America Heart Institute Hospital Kansas City Missouri USA

Division of Cardiology University of Michigan Medical Center Ann Arbor Michigan USA

Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville Tennessee USA

Division of Pediatric Cardiology Children's National Hospital Washington DC USA

European Reference Network for Rare Low Prevalence and Complex Disease of the Heart ERN Guard Heart Amsterdam the Netherlands

Green Lane Paediatric and Congenital Cardiac Service Auckland City Hospital Auckland New Zealand

Helen B Taussig Heart Center Department of Pediatrics Johns Hopkins University Baltimore Maryland USA

Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

Internal Medicine Cardiology University of Alberta Edmonton Alberta Canada

Knight Cardiovascular Institute Oregon Health and Science University Portland Oregon USA

Ochsner Medical Center New Orleans Los Angeles USA

Peter Munk Cardiac Center Toronto General Hospital University Health Network University of Toronto Ontario Canada

Providence Adult and Teen Congenital Heart Program Providence Spokane Spokane Washington USA

St Paul's Hospital Division of Cardiology University of British Columbia Vancouver British Columbia Canada

Stanford University School of Medicine Departments of Pediatrics and Medicine Palo Alto California USA

University of Washington Medical Center and Seattle Children's Hospital Seattle Washington USA

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