Renin‐Angiotensin System Blockade in Aortic Stenosis: Implications Before and After Aortic Valve Replacement

Abstract Aortic stenosis (AS) is a common valvular heart disease in the aging population that is characterized by a variable period of asymptomatic phase before development of symptoms and severe AS. Mortality and morbidity is substantial even after aortic valve replacement, in part related to persistent left ventricular hypertrophy, diastolic dysfunction, and heart failure. Renin‐angiotensin system (RAS) blockade therapy is associated with modulation of adverse left ventricular remodeling, reduction in myocardial hypertrophy, and fibrosis, resulting in clinical improvements in patients with congestive heart failure There are emerging data to suggest benefit of RAS blockade in patients with AS before and after AVR with regard to potentially slower progression of aortic valve calcification, left ventricular mass and survival benefit in favor of RAS blockade group before AVR, and also survival benefit in patients after AVR. We review the available data to understand the role of RAS blockade before AVR and in patients undergoing surgical AVR and transcatheter AVR. There are significant survival advantages of RAS inhibition in patients with AS undergoing surgical AVR or transcatheter AVR. On the basis of existing literature, adequately powered randomized trials are needed to evaluate the role of RAS inhibition in patients with AS.

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Neurohumoral changes during onset and offset of ovine heart failure: role of ANP

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1989.256.4.h1052 ◽

1989 ◽

Vol 256 (4) ◽

pp. H1052-H1059 ◽

Cited By ~ 12

Author(s):

M. A. Fitzpatrick ◽

M. G. Nicholls ◽

E. A. Espiner ◽

H. Ikram ◽

P. Bagshaw ◽

...

Keyword(s):

Heart Failure ◽

Renin Angiotensin System ◽

Close Correlation ◽

Left Ventricular ◽

Base Line ◽

Angiotensin System ◽

Major Increase ◽

Left Ventricular Pacing ◽

Relationship Of

The temporal relationship of changes in atrial natriuretic peptide (ANP) secretion to other pathophysiological changes in heart failure has not been investigated. We studied the hemodynamic, hormonal, and metabolic changes before, during, and after the induction of heart failure in eight sheep using a 14-day period of rapid left ventricular pacing (LVP). Arterial pressure declined 21% on the first day, while cardiac output fell progressively to 48% of base line, and atrial pressures rose to a plateau over the first week. Plasma ANP levels increased 10-fold with a close correlation to left atrial pressure in all sheep. Furthermore, ANP secretion appeared to be sustained throughout the LVP period but did not prevent avid sodium retention. Marked and early activation of the renin-angiotensin system was observed, whereas the major increase in plasma aldosterone commenced 4 days later. On termination of LVP, a prompt natriuresis and diuresis occurred with return of all parameters toward base line. Thus this ovine model is useful for studying pathophysiological changes during the onset and offset of heart failure.

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TCT-750 Role of Renin-Angiotensin System Blockade Therapy Following Aortic Valve Replacement for Severe Aortic Stenosis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.07.822 ◽

2014 ◽

Vol 64 (11) ◽

pp. B219 ◽

Cited By ~ 1

Author(s):

Sachin S. Goel ◽

Olcay Aksoy ◽

Penny Houghtaling ◽

E. Murat Tuzcu ◽

Tomislav Mihaljevic ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Renin Angiotensin System ◽

Angiotensin System ◽

Renin Angiotensin

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Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension

Current Vascular Pharmacology ◽

10.2174/1570161116666180101165306 ◽

2019 ◽

Vol 17 (2) ◽

pp. 180-190 ◽

Cited By ~ 3

Author(s):

V. Katsi ◽

G. Georgiopoulos ◽

D. Oikonomou ◽

C. Aggeli ◽

C. Grassos ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Regurgitation ◽

Antihypertensive Agents ◽

Renin Angiotensin System ◽

Aortic Disease ◽

Review Of The Literature ◽

Angiotensin System ◽

The Impact ◽

Worse Prognosis

Background: Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. Objective: To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. Methods: We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. Results: Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. Conclusion: Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.

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