Effect of renin angiotensin system blockade following transcatheter aortic valve replacement is dose dependent

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Ledwoch ◽  
I Olbrich ◽  
F Poch ◽  
R Thalmann ◽  
C Fellner ◽  
...  
Keyword(s):  
Transcatheter Aortic Valve Replacement ◽  
Renin Angiotensin System ◽  
Left Ventricular ◽  
Angiotensin System ◽  
Transcatheter Aortic Valve ◽  
Maximum Daily Dose ◽  
Lv Remodeling ◽  
All Cause Mortality ◽  
Daily Dose ◽  
Dose Dependent

Abstract Background There is growing body of evidence from retrospective studies that inhibition of the renin angiotensin system (RAS) improves outcome after transcatheter aortic valve replacement (TAVR). However, it remains unknown whether the effect of RAS blockade treatment on survival and left ventricular (LV) remodeling after TAVR is dose dependent. Purpose To assess clinical outcome and remodeling dependent on different RAS doses after TAVR. Methods Patients who were enrolled into our observational TAVR study at our institution were retrospectively assessed according to different dosed of RAS blockade: Group1 (no RAS blockade), group 2 (25% of the maximum daily dose), group 3 (50% of the maximum daily dose) and group 4 (100% of the maximum daily dose). Results A total of 323 patients between January 2015 and September 2019 were included. Patients with higher doses of RAS blockade showed a trend towards lower all-cause mortality at 3-year follow-up (56% with no RAS blockade vs. 66% with the 25% dose vs. 79% with the 50% dose vs. 78% with the full dose; p=0.063). After adjustment for baseline characteristics the difference in survival was significant (p=0.042). Besides NYHA class ≥ III and left ventricular ejection fraction (LV-EF) RAS blockade dose was identified as independent predictor for all-cause mortality (HR 0.72 [95% CI 0.54–0.97]; p=0.03). With respect to regression of LV mass index after TAVR the only significant change was observed in patients receiving the full dose. Conclusion The present study showed for the first time that the impact of RAS blockade treatment on clinical outcome and LV remodeling after TAVR is dose dependent. Survival dependent on RAS dosis Funding Acknowledgement Type of funding source: None

scholarly journals Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement

2019 ◽  
Vol 74 (5) ◽  
pp. 631-641 ◽  
Author(s):  
Tania Rodriguez-Gabella ◽  
Pablo Catalá ◽  
Antonio J. Muñoz-García ◽  
Luis Nombela-Franco ◽  
Raquel Del Valle ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Transcatheter Aortic Valve

scholarly journals Predictors of left ventricular ejection fraction recovery after transcatheter aortic valve replacement (TAVR)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Peiro Aventin ◽  
E Gambo Ruberte ◽  
T Simon Paracuellos ◽  
D Gomez Martin ◽  
A Perez Guerrero ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ejection Fraction ◽  
Transcatheter Aortic Valve Replacement ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality

Abstract Introduction Transcatheter aortic valve replacement (TAVR) has proven benefits in patients with reduced left ventricular ejection fraction (LVEF). A significant proportion of them shows recovery of systolic function Objective To analyse the main baseline, electrocardiographic and echocardiographic characteristics that may predict LVEF recovery after TAVR. Methods A cohort study was conducted. Consecutive patients undergoing TAVR in our center from January 2012 to December 2020 were included. Baseline clinical profile, electrocardiographic (EKG), echocardiographic (ECH) parameters were recorded, as well as MACE during follow-up (major adverse cardiovascular events including: all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization). Reduced systolic function was defined as LVEF <50%. We considered recovery of systolic function as LVEF ≥50% at follow-up. Results A total of 292 patients were included. 48% were women and the median age was 81.07 years (77.63–86.22). 22.6% (66 patients) had reduced LVEF at baseline. Half of them showed recovered systolic function during follow-up. Patients who did not recovered LVEF had a higher prevalence of dyslipidemia and peripheral artery disease. History of cardiac surgery was more frequently found in this group, and they showed a higher surgical risk estimated by EuroScore II. They had lower LVEF and aortic valve mean gradient, and more frequently presented non-synus rhythm (NSR), left bundle branch block and right ventricular dysfunction (RVD). These characteristics are shown in figure 1. In univariate analysis lower Euroscore II, presence of synus rhythm, absence of LBBB and RVD, as well as higher aortic valve mean gradient were predictors of LVEF recovery. In multivariate analysis RVD and mean aortic gradient were independent predictors. Among all patients included in our study, those presenting with RV dysfunction were significantly associated with lower LVEF mean values (46,0% vs 57,2%; p<0,01) After a median follow-up of 21.3 (8.52–38.94) months, MACE were lower in recovered LVEF group (HR 0.25 95% CI: 0.05–1.21). There were no statistically significant differences in all-cause mortality, nevertheless there was a trend towards a higher non-cardiovascular mortality in this group, essentially at the expense of deaths from malignant neoplasms and SARS-COV-2 infections. Survival curves for MACE are represented in figure 2. Conclusion In our study, half of the patients with impaired ventricular function undergoing TAVR showed recovery of ejection fraction. Right ventricular function and aortic valve mean gradient at baseline were independent predictors of recovery. Identifying predictors of LVEF recovery is fundamental in the evaluation of potential candidates for TAVR, and can help clinicians assess risks and benefits, as well as long-term prognosis of these patients. FUNDunding Acknowledgement Type of funding sources: None. Characteristics and analysis Survival curves for MACE

Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation

Heart ◽  
2017 ◽  
Vol 104 (8) ◽  
pp. 644-651 ◽  
Author(s):  
Tomoki Ochiai ◽  
Shigeru Saito ◽  
Futoshi Yamanaka ◽  
Koki Shishido ◽  
Yutaka Tanaka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Ace Inhibitors ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Transcatheter Aortic Valve ◽  
Lv Mass ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

ObjectiveThe persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin−angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI.MethodsBetween October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189).ResultsAt 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group (−9±24% vs −2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025).ConclusionsPostoperative RAS blockade therapy is associated with greater LV mass index regression and reduced all-cause mortality. These data need to be confirmed by a prospective randomised controlled outcome trial.

scholarly journals Impact of renin–angiotensin system inhibitors on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis of from the PARTNER 2 trial and registries

2019 ◽  
Vol 41 (8) ◽  
pp. 943-954 ◽  
Author(s):  
Shmuel Chen ◽  
Bjorn Redfors ◽  
Tamim Nazif ◽  
Ajay Kirtane ◽  
Aaron Crowley ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Cardiovascular Mortality ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Renin Angiotensin System ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Transcatheter Aortic Valve

Abstract Aims Left ventricular pressure overload is associated with activation of the cardiac renin–angiotensin system, which may contribute to myocardial fibrosis and worse clinical outcomes. We sought to assess the association between treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) at baseline and clinical outcomes in patients with symptomatic, severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) in the PARTNER 2 trial and registries. Methods and results A total of 3979 intermediate, high, or prohibitive risk patients who underwent TAVR in the PARTNER 2 trial and registries (excluding the valve in valve registry) were included in the study. Clinical outcomes at 2 years were compared according to baseline ACEI/ARB treatment status using Kaplan–Meier event rates and study-stratified multivariable Cox proportional hazards regression models. Sensitivity analysis was conducted using propensity score matching. Of 3979 patients who were included in the current analysis, 1736 (43.6%) were treated and 2243 (56.4%) were not treated with ACEI/ARB at baseline. Treatment with ACEI/ARB was associated with lower 2-year all-cause mortality (18.6% vs. 27.5%, P < 0.0001), cardiovascular mortality (12.3% vs. 17.9%, P < 0.0001), and non-cardiovascular mortality (7.2% vs. 11.7%, P < 0.0001). Angiotensin-converting enzyme inhibitor/ARB treatment at baseline remained independently associated with a lower hazard of 2-year all-cause and cardiovascular mortality after multivariable adjustment, and propensity score matching. Conclusion In a large cohort of patients with severe symptomatic AS from the PARTNER 2 trial and registries, ACEI/ARB treatment at baseline was independently associated with a lower risk of 2-year all-cause and cardiovascular mortality.

Impact of paravalvular leak on left ventricular remodeling and global longitudinal strain 1 year after transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Polydoros N Kampaktsis ◽  
Pritha Subramayam ◽  
Ines Sherifi ◽  
Manolis Vavuranakis ◽  
Gerasimos Siasos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Lv Mass ◽  
Lv Remodeling ◽  
Lv Ejection Fraction

Background: New mild or persistent moderate paravalvular leak (PVL) is a known predictor of poor outcomes after transcatheter aortic valve replacement (TAVR). Its impact on left ventricular (LV) remodeling and global longitudinal strain (GLS) has not been well studied. Materials & methods: We collected echocardiographic data in 99 TAVR patients. LV remodeling and GLS were compared between patients with and without PVL. Results: Patients without PVL (n = 84) had significant LV ejection fraction, wall thickness and LV mass improvement compared with patients with PVL (n = 15; p < 0.001 for all). Diastolic function worsened in patients with PVL. Baseline GLS improved significantly regardless of PVL (p = 0.016 and p = 0.01, respectively) and was not predictive of LV ejection fraction or LV mass improvement when analyzed in tertiles. Conclusion: PVL impedes reverse LV remodeling but not GLS improvement 1-year after TAVR. Baseline GLS was not a predictor of LV remodeling.

Abstract 14646: Left Ventricular Global Longitudinal Strain and CT Derived Extracellular Volume Predicts Outcomes in Patients With Low-flow, Low-gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maulin B Shah ◽  
Suzanne Oskouie ◽  
Nir Flint ◽  
James Mirocha ◽  
Donghee Han ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Replacement ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Low Flow ◽  
Transcatheter Aortic Valve ◽  
Lv Remodeling

Introduction: Low-flow, low-gradient aortic stenosis (LFLG-AS) is associated with impaired left ventricular (LV) function and afterload mismatch. Indications and timing for transcatheter aortic valve replacement (TAVR) in LFLG-AS do not account for the presence of subclinical LV remodeling. We evaluated whether combining LV global longitudinal strain (GLS) and CT-derived extracellular volume (ECV), both markers of LV remodeling, provides incremental prediction of adverse outcomes in patients with LFLG-AS undergoing TAVR. Methods: We retrospectively evaluated patients with LFLG-AS undergoing TAVR in whom pre-TAVR CT-based ECV measurements were available. GLS was measured in pre-TAVR echocardiograms using speckle tracking. Cox regression analysis was performed with a primary outcome of heart failure hospitalization (HFH) or death. Four sub-groups were identified for analysis based on optimal cutoff points: Group 1 (n=64): ECV< 33 + GLS≥

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