Renin-Angiotensin System Inhibition and Cardiac Damage in Patients Undergoing Transcatheter Aortic Valve Replacement.

Tomii, Daijiro; Okuno, Taishi; Nakase, Masaaki; Praz, Fabien; Stortecky, Stefan; Reineke, David; Windecker, Stephan; Lanz, Jonas; Pilgrim, Thomas (2024). Renin-Angiotensin System Inhibition and Cardiac Damage in Patients Undergoing Transcatheter Aortic Valve Replacement. (In Press). The Canadian journal of cardiology Elsevier 10.1016/j.cjca.2024.07.019

Preview

Text 1-s2.0-S0828282X24005774-main.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (3MB) | Preview

BACKGROUND

The optimal medical treatment strategy after transcatheter aortic valve replacement (TAVR) has not been established, and may be impacted by the extent of extra-valvular cardiac damage. We aimed to investigate the prognostic effect of renin-angiotensin system (RAS) inhibitors in TAVR patients stratified by the extent of extra-valvular cardiac damage.

METHODS

In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into five stages of cardiac damage (0-4) according to established criteria. Clinical outcomes at 1 year were compared according to RAS inhibitor prescription at discharge.

RESULTS

Among 2,247 eligible patients undergoing TAVR between August 2007 and June 2021, 1,634 (72.7%) were prescribed RAS inhibitors at discharge. Eighty-three patients (3.7%) were classified as Stage 0, 276 (12.3%) as Stage 1, 889 (39.6%) as Stage 2, 489 (21.8%) as Stage 3, and 510 (22.7%) as Stage 4. RAS inhibitor prescription after TAVR was associated with a reduced risk of 1-year mortality (HRadjusted 0.59, 95% CI 0.45-0.77). The protective effect was accentuated among patients with cardiac stage 3 and 4 (HRadjusted 0.54, 95% CI 0.32-0.92 and HRadjusted 0.58, 95% CI 0.36-0.92, respectively), but not statistically significant in stages 2 (HRadjusted 0.70, 95% CI 0.43-1.14).

CONCLUSIONS

In patients undergoing TAVR, we found a strong association of RAS inhibitor prescription and improved clinical outcome in the overall population, and there were no signs of heterogeneity across stages of cardiac damage.

Interest & Impact

Downloads

6 since deposited on 29 Jul 2024
6 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item