New Evidence About Aortic Valve Stenosis and Cardiovascular Hemodynamics

Mancusi, Costantino; Bahlmann, Edda; Basile, Christian; Gerdts, Eva

doi:10.1007/s40292-022-00520-x

Cited by 3 publications

(1 citation statement)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ACEIs/ARBs also reduce blood pressure (BP) levels, hence decreasing the overall LV hemodynamic burden (5). Until a few years ago, ACEIs/ARBs were considered potentially harmful and even contraindicated in severe AS because they could potentially cause a rapid and harmful decrease in BP levels (6). However, a recent metaanalysis that included observational and randomized evidence indicated that ACEIs/ARBs could be harmless and could even be helpful for treating AS (4,7,8).…”

Section: Introductionmentioning

confidence: 99%

Renin–angiotensin system inhibitors reduce cardiovascular mortality in hypertensive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry

Basile,

Mancusi,

Franzone

et al. 2023

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

ObjectivesArterial hypertension is associated with the triggering of the renin–angiotensin system, leading to left ventricle fibrosis and worse cardiovascular outcomes. In this study, patients with comorbid arterial hypertension and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) were selected from the EffecTAVI registry to evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on cardiovascular mortality.MethodsWe enrolled 327 patients undergoing TAVI from the EffecTAVI registry. Using Kaplan–Meier event rates and study-stratified multivariable Cox proportional hazards regression models, we evaluated 2-year clinical outcomes according to the ACEI/ARB therapy status at enrollment.ResultsAmong the included patients, 222 (67.9%) were on ACEIs/ARBs at baseline, whereas 105 (32.1%) were not. Treatment with ACEIs/ARBs was significantly associated with a 2-year decrease in the rate of cardiovascular mortality (HR = 0.44, 95% CI: 0.23–0.81, p = 0.009). This association remained stable after both multivariable adjustment and propensity score matching.ConclusionIn a cohort of hypertensive patients with severe AS who were selected from the EffecTAVI registry, ACEI/ARB treatment at baseline was found to be independently associated with a lower risk of 2-year cardiovascular mortality, suggesting a potential benefit of this treatment. More trials are needed to validate this finding and to understand the full benefit of this treatment.

show abstract

Section: Introductionmentioning

confidence: 99%

Renin–angiotensin system inhibitors reduce cardiovascular mortality in hypertensive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry

Basile,

Mancusi,

Franzone

et al. 2023

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

show abstract

Flow down gradients: the problem of pressure in this physiology core concept

Nocke

Meyer

Leßmann

2023

Advances in Physiology Education

View full text Add to dashboard Cite

The core concepts of physiology, as first published in this journal in 2011, not only provide a noteworthy teaching approach but also encourage reflection on the fundamentals of physiology. Unfortunately, a fundamental flaw has crept into the core concept of flow down gradients. Fluids do not generally flow from high to low pressure, as claimed, but only because of a specific pressure difference, that is, the perfusion pressure. This is related to a problem that is widespread in physiology, from which even the core concepts are not free, namely, the description of mean arterial pressure (MAP) solely by means of Ohm's law of circulation, although this law actually describes perfusion pressure. Both pressures can be numerically approximately equal in the physiological case, but conceptually they remain different in principle. We solved this problem using the extended Bernoulli equation (a combination of Ohm's law and the simple Bernoulli equation). Thereafter, MAP depends on the following pressure components, all of which are essential for a basic understanding of circulation: perfusion, central venous, gravitational, and dynamic pressures. These pressures also have great pathophysiological and clinical importance, which we exemplify here. Towards the end of this paper, we provide recommendations that should be considered in teaching, whether it is a beginner or advanced course. We address physiology teachers who are open to critical constructive improvements in their teaching, especially in hemodynamics. In particular, we encourage the authors of the flow down gradients core concept to improve and refine its "unpacking."

show abstract