Dose-Dependent Effect of Renin-Angiotensin System Blockade Following Transcatheter Aortic Valve Replacement

Ledwoch, Jakob; Olbrich, Ida; Poch, Felix; Thalmann, Ruth; Fellner, Carmen; Stundl, Anja; Bradaric, Christian; Laugwitz, Karl‐Ludwig; Kupatt, Christian

doi:10.1016/j.cjca.2020.08.014

Cited by 10 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Approximately 40-60% of all patients undergoing TAVR and nearly half of patients with LVEF ≤40% undergoing TAVR, are discharged on at least one renin-angiotensin system (RAS) inhibitor. [72][73][74][75][76] RAS inhibition has been associated with lower rates of mid-term all-cause mortality, cardiovascular mortality, HF readmission, cerebrovascular events, and new-onset atrial fibrillation. [73][74][75][76][77] In the PARTNER 2 trial and registries, RAS inhibition at baseline was independently associated with a lower risk of 2-year all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality.…”

Section: Medical Therapy In Heart Failure Patients Undergoing Transca...mentioning

confidence: 99%

“…[72][73][74][75][76] RAS inhibition has been associated with lower rates of mid-term all-cause mortality, cardiovascular mortality, HF readmission, cerebrovascular events, and new-onset atrial fibrillation. [73][74][75][76][77] In the PARTNER 2 trial and registries, RAS inhibition at baseline was independently associated with a lower risk of 2-year all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality. 73 RAS inhibitors following TAVR have also been associated with significant reductions in left ventricular volumes and hypertrophy 74 and improved KCCQ scores.…”

Section: Medical Therapy In Heart Failure Patients Undergoing Transca...mentioning

confidence: 99%

“…75 Furthermore, a significantly larger reduction of left ventricular mass index has been noted with higher doses of RAS blockade. 76 Discontinuation of RAS inhibition, which has been reported in patients with post-procedural acute kidney injury or pacemaker requirement, has been reported in one in three patients undergoing TAVR. 72 Whether inhibition of RAS and sodium-glucose cotransporter 2 (SGLT2) can prevent or reverse left ventricular remodelling post-TAVR and affect long-term outcomes remains unclear.…”

Section: Medical Therapy In Heart Failure Patients Undergoing Transca...mentioning

confidence: 99%

See 2 more Smart Citations

Transcatheter aortic valve replacement in heart failure

Parikh,

Mack,

Stone

et al. 2024

European J of Heart Fail

View full text Add to dashboard Cite

Patients with severe aortic stenosis (AS) may develop heart failure (HF), the presence of which has traditionally been deemed as a final stage in AS progression with poor outcomes. The use of transcatheter aortic valve replacement (TAVR) has become the preferred therapy for most patients with AS and concomitant HF. With its instant afterload reduction, TAVR offers patients with HF significant haemodynamic benefits, with corresponding changes in left ventricular structure and improved mortality and quality of life. The prognostic covariates and optimal timing of TAVR in patients with less than severe AS remain unclear. The purpose of this review is to describe the association between TAVR and outcomes in patients with HF, particularly in the setting of left ventricular systolic dysfunction, acute HF, and right ventricular systolic dysfunction, and to highlight areas for future research.

show abstract

Section: Medical Therapy In Heart Failure Patients Undergoing Transca...mentioning

confidence: 99%

Section: Medical Therapy In Heart Failure Patients Undergoing Transca...mentioning

confidence: 99%

Section: Medical Therapy In Heart Failure Patients Undergoing Transca...mentioning

confidence: 99%

See 1 more Smart Citation

Transcatheter aortic valve replacement in heart failure

Parikh,

Mack,

Stone

et al. 2024

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

“…12 full-text articles were reviewed, and 5 articles were removed (12)(13)(14)(15)(16). Altogether, 7 articles (6,7,(17)(18)(19)(20)(21) were included, with a total of 32,585 patients (RAS inhibitor, N = 14,871; Controls, N = 17,714). The full search process is shown in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

“…Several studies evaluated the association between RAS inhibitors and the clinical outcomes of patients after TAVR. For example, Ledwoch et al evaluated the dose of RAS inhibitors on clinical outcomes and demonstrated that increasing doses of RAS inhibitor could improve the 3-year survival in patients after TAVR ( 6 ). A recent study showed the benefits between improved survival and RAS inhibitors may be dose-dependent and particularly evident in high-risk patients ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

The clinical outcomes of reni-angiotensin system inhibitors for patients after transcatheter aortic valve replacement: A systematic review and meta-analysis

Wang

Lin

Guan

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

AimsThe objective of our systematic reviews and meta-analysis is to evaluate the clinical outcomes of RAS inhibitors for patients after TAVR.Methods and resultsWe performed a comprehensive search for Embase, Pubmed, and Cochrane databases from inception to May 1, 2022. The analysis of all outcomes was performed using the random-effects model. In total, 7 articles with a total of 32,585 patients (RAS inhibitor, N = 14,871; Controls, N = 17,714) were included in our study. There was a significantly lower rates of all-cause mortality (RR = 0.76, 95%Cl = 0.68 to 0.86, P < 0.01), cardiovascular death (RR = 0.66, 95%Cl = 0.59–0.74, P < 0.01) and HF readmission (RR = 0.87, 95%Cl = 0.80–0.94, P < 0.01) in patients with RAS inhibitors compared with controls. Patients with RAS inhibitors also had lower rates of all-cause mortality (RR = 0.82, 95%Cl = 0.76–0.89, P < 0.01) and cardiovascular death (RR = 0.73, 95%Cl, 0.62–0.85, P < 0.01) after propensity matching.ConclusionsIn conclusion, our systematic reviews and meta-analysis demonstrated that RAS inhibitors could improve the clinical outcomes for patients after TAVR. Further large and high-quality trials should be conducted to support the use of RAS inhibitors for patients after TAVR.

show abstract