Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation

Ochiai, Tomoki; Saïto, Shigeru; Yamanaka, Futoshi; Shishido, Koki; Tanaka, Yutaka; Yamabe, Tsuyoshi; Shirai, Shinichi; Tada, Norio; Araki, Motoharu; Naganuma, Toru; Watanabe, Yusuke; Yamamoto, Masanori; Hayashida, Kentaro

doi:10.1136/heartjnl-2017-311738

Cited by 69 publications

(40 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Resultsmentioning

confidence: 99%

“…58 The Optimised CathEter vAlvular iNtervention-transcatheter aortic valve implantation (TAVI) registry also showed that using propensity score-matched cohort analysis, patients with RAASi postoperatively had greater LVH regression than without (mean change in LV mass index of −9 vs −2 g/m 2 , p=0.024) in 6 months post-AVR. 47 Safety outcomes post-AVR Overall, post-TAVI, the risk of acute kidney injury was not significantly lower in patients on AHT compared with controls (RR 0.80, 95% CI 0.35 to 1.84, p=0.47), but substantial heterogeneity was demonstrated (I 2 =53%). An RCT called the PROphylactic effect of frusemide-induCed diuresis with matched isotonic intravenous hydraTion in TAVI showed that frusemide-induced diuresis reduced incidence of acute kidney injury post-TAVI, but the duration of follow-up was only 30 days.…”

Section: Overall Random Effectmentioning

confidence: 95%

See 1 more Smart Citation

Antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

BackgroundHypertension confers a poor prognosis in moderate or severe aortic stenosis (AS), however, antihypertensive therapy (AHT) is often not prescribed due to the perceived deleterious effects of vasodilation and negative inotropes.ObjectiveTo assess the efficacy and safety outcomes of AHT in adults with moderate or severe AS.DesignSystematic review and meta-analysis.Data sourcesThe Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and grey literature were searched without language restrictions up to 9 September 2019.Study eligibility criteria, appraisal and synthesis methodsTwo independent reviewers performed screening, data extraction and risk of bias assessments from a systematic search of observational studies and randomised controlled trials comparing AHT with a placebo or no AHT in adults with moderate or severe AS for any parameter of efficacy and safety outcomes. Conflicts were resolved by the third reviewer. Meta-analysis with pooled effect sizes using random-effects model, were estimated in R.Main outcome measuresMortality, Left Ventricular (LV) Mass Index, systolic blood pressure, diastolic blood pressure and LV ejection fractionResultsFrom 3025 publications, 31 studies (26 500 patients) were included in the qualitative synthesis and 24 studies in the meta-analysis. AHT was not associated with mortality when all studies were pooled, but heterogeneity was substantial across studies. The effect size of AHT differed according to drug class. Renin–angiotensin–aldosterone system inhibitors (RAASi) were associated with reduced risk of mortality (Pooled HR 0.58, 95% CI 0.43 to 0.80, p=0.006), The differences in changes of haemodynamic or echocardiographic parameters from baseline with and without AHT did not reach statistical significance.ConclusionAHT appears safe, is well tolerated. RAASi were associated with clinical benefit in patients with moderate or severe AS.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Overall Random Effectmentioning

confidence: 95%

Antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Also, one single study has analysed retrospectively the effects of RAS blockade in patients harbouring a TAVI device suggesting that this therapy could be associated with greater left ventricular mass index regression and reduced all-cause mortality. 32 However, any randomised trial has confirmed this hypothesis. The RASTAVI Study is the first formal attempt to clarify the role of RAS inhibitors in the prognosis of these patients.…”

Section: Methods and Analysismentioning

confidence: 99%

Impact of renin-angiotensin system inhibitors on clinical outcomes and ventricular remodelling after transcatheter aortic valve implantation: rationale and design of the RASTAVI randomised multicentre study

et al. 2018

View full text Add to dashboard Cite

IntroductionTranscatheter aortic valve implantation (TAVI) as a treatment in severe aortic stenosis (AS) is an excellent alternative to conventional surgical replacement. However, long-term outcomes are not benign. Renin-angiotensin system (RAS) blockade has shown benefit in terms of adverse remodelling in severe AS and after surgical replacement.Methods and analysisThe RAS blockade after TAVI (RASTAVI) trial aims to detect if there is a benefit in clinical outcomes and ventricular remodelling with this therapeutic strategy following the TAVI procedure. The study has been designed as a randomised 1:1 open-label study that will be undertaken in 8 centres including 336 TAVI recipients. All patients will receive the standard treatment. The active treatment group will receive ramipril as well. Randomisation will be done before discharge, after signing informed consent. All patients will be followed up for 3 years. A cardiac magnetic resonance will be performed initially and at 1 year to assess ventricular remodelling, defined as ventricular dimensions, ejection fraction, ventricular mass and fibrosis. Recorded events will include cardiac death, admission due to heart failure and stroke. The RASTAVI Study will improve the management of patients after TAVI and may help to increase their quality of life, reduce readmissions and improve long-term survival in this scenario.Ethics and disseminationAll authors and local ethics committees have approved the study design. All patients will provide informed consent. Results will be published irrespective of whether the findings are positive or negative.Trial registration numberNCT03201185.

show abstract

“…Furthermore, the capability of ACEI/ARB to attenuate also myocardial fibrosis [56], presumably less responsive to post-procedural afterload reduction than myofibrillar hypertrophy, is especially promising in post-TAVI patients, because the extent of preoperative-myocardial fibrosis predisposed to the post-operative persistence of residual LVH [38]. In a registry of 1,215 patients undergoing TAVI, Ochiai et al [63] recently demonstrated 4-fold higher 6-month regression of LV mass (9% vs. 2%) and over 2-fold lower all-cause 2-year mortality in patients treated with ACEI or ARB after the procedure.…”

Section: Renin-angiotensin System Blockade In As – a Tool To Inhibit mentioning

confidence: 99%

Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis?

Davies

Zerebiec

Rożanowska

et al. 2018

pwki

View full text Add to dashboard Cite

Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade.

show abstract

Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation

Abstract: Postoperative 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.

Cited by 69 publications

References 30 publications

Antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis

Antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis

Impact of renin-angiotensin system inhibitors on clinical outcomes and ventricular remodelling after transcatheter aortic valve implantation: rationale and design of the RASTAVI randomised multicentre study

Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis?

Contact Info

Product

Resources

About