Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement

Rodríguez‐Gabella, Tania; Catalá, Pablo; Muñoz-García, Antonio J.; Nombela‐Franco, Luis; Valle, Raquel del; Gutiérrez, Enrique; Regueiro, Ander; Jiménez-Díaz, Víctor Alfonso; Ribeiro, Henrique Barbosa; Rivero, Fernando; Fernández-Díaz, José Antonio; Pîbarot, Philippe; Alonso‐Briales, Juan H.; Tirado‐Conte, Gabriela; Morís, César; Hoyo, Felipe Díez del; Jiménez-Brítez, Gustavo; Zaderenko, Nicolás; Alfonso, Fernándo; Gómez, Itzíar; Carrasco-Moraleja, Manuel; Rodés‐Cabau, Josep; Calvar, José Alberto San Román; Amat‐Santos, Ignacio J.

doi:10.1016/j.jacc.2019.05.055

Cited by 63 publications

(55 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The modifiable factors among the predictors listed in Box 1 should be medically optimised: anaemia may be corrected with transfusion and iron supplementation, and maximal therapy to control diabetes, AF and kidney, liver and lung diseases should be instituted prior to TAVR. Pharmacologically, prescription of a renin-angiotensin system (RAS) inhibitor has been show in a TVT Registry analysis to decrease 1-year heart failure readmission following TAVR (HR 0.86, 95% CI 0.79 to 0.95), regardless of LVEF (p=0.84 for interaction) or renal function (p=0.42 for interaction)36; the association of RAS inhibition with reduced readmission has also been shown in a prospective observational 10-centre study37 and is the subject of a single-arm prospective clinical trial (RASTAVI, NCT03201185). Because impaired pre-TAVR functional capacity, as typified by slow gait speed, and nutrition, as typified by hypoalbuminaemia, are associated with readmission, preprocedure physical therapy (‘prehab’) and protein supplementation may also reduce readmission; the randomised Protein and Exercise to Reverse Frailty in OldeR Men and women undergoing Transcatheter Aortic Valve Replacement (PERFORM-TAVR) trial (NCT03522454) is currently testing this hypothesis.…”

Section: Introductionmentioning

confidence: 86%

Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Goldsweig

Aronow

2019

Heart

View full text Add to dashboard Cite

Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.

show abstract

Section: Introductionmentioning

confidence: 86%

Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Goldsweig

Aronow

2019

Heart

View full text Add to dashboard Cite

show abstract

“…Currently, Spain presents one of the highest rates of confirmed COVID-19 cases and of deaths per million in the world. The RASTAVI trial is investigating the effect of adding ramipril to the standard care in patients successfully treated with percutaneous aortic valve in terms of ventricular remodeling as assessed by cardiac magnetic resonance and in the major clinical outcomes(19,20).…”

mentioning

confidence: 99%

Ramipril in High-Risk Patients With COVID-19

Amat‐Santos

Santos‐Martínez

López-Otero

et al. 2020

Journal of the American College of Cardiology

Self Cite

View full text Add to dashboard Cite

BACKGROUND Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory-syndrome coronavirus-2 that interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting enzyme 2. This interaction has been proposed as a potential risk factor in patients treated with RAAS inhibitors. OBJECTIVES This study analyzed whether RAAS inhibitors modify the risk for COVID-19. METHODS The RASTAVI (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation) trial is an ongoing randomized clinical trial randomly allocating subjects to ramipril or control groups after successful transcatheter aortic valve replacement at 14 centers in Spain. A non-prespecified interim analysis was performed to evaluate ramipril's impact on COVID-19 risk in this vulnerable population. RESULTS As of April 1, 2020, 102 patients (50 in the ramipril group and 52 in the control group) were included in the trial. Mean age was 82.3 AE 6.1 years, 56.9% of the participants were male. Median time of ramipril treatment was 6 months (interquartile range: 2.9 to 11.4 months). Eleven patients (10.8%) have been diagnosed with COVID-19 (6 in control group and 5 receiving ramipril; hazard ratio: 1.150; 95% confidence interval: 0.351 to 3.768). The risk of COVID-19 was increased in older patients (p ¼ 0.019) and those with atrial fibrillation (p ¼ 0.066), lower hematocrit (p ¼ 0.084), and more comorbidities according to Society of Thoracic Surgeons score (p ¼ 0.065). Admission and oxygen supply was required in 4.9% of patients (2 in the ramipril group and 3 in the control group), and 4 of them died (2 in each randomized group). A higher body mass index was the only factor increasing the mortality rate (p ¼ 0.039). CONCLUSIONS In a high-risk population of older patients with cardiovascular disease, randomization to ramipril had no impact on the incidence or severity of COVID-19. This analysis supports the maintenance of RAAS inhibitor treatment during the COVID-19 crisis. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185)

show abstract

“…Some preclinical and clinical studies have shown that Sac/Val is safer and more efficient than the ACEI enalapril for improving primary outcomes and lowering mortality rates in heart failure [ 8 , 27 ]. A recent clinical report has shown that ACEI treatment post TAVR offers a global protective effect and decreases the rate of cardiac mortality; these effects are at least partly related to improving cardiac remodeling [ 28 ]. However, the effect of Sac/Val on clinical outcomes following successful TAVR remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Protection of Sacubitril/Valsartan against Pathological Cardiac Remodeling by Inhibiting the NLRP3 Inflammasome after Relief of Pressure Overload in Mice

Zhu

Wang

et al. 2020

Cardiovasc Drugs Ther

View full text Add to dashboard Cite

Background/aims The persistent existence of pathological cardiac remodeling, resulting from aortic stenosis, is related to poor clinical prognosis after successful transcatheter aortic valve replacement (TAVR). Sacubitril/valsartan (Sac/Val), comprising an angiotensin receptor blocker and a neprilysin inhibitor, has been demonstrated to have a beneficial effect against pathological cardiac remodeling, including cardiac fibrosis and inflammation in heart failure. The aim of this study was to determine whether Sac/Val exerts a cardioprotective effect after pressure unloading in mice. Methods and results Male C57BL/6 J mice were subjected to debanding (DB) surgery after 8 weeks (wk) of aortic banding (AB). Cardiac function was assessed by echocardiography, which indicated a protective effect of Sac/Val after DB. After treatment with Sac/Val post DB, decreased heart weight and myocardial cell size were observed in mouse hearts. In addition, histological analysis, immunofluorescence, and western blot results showed that Sac/Val attenuated cardiac fibrosis and inflammation after DB. Finally, our data indicated that Sac/Val treatment could significantly suppress NF-κB signaling and NLRP3 inflammasome activation in mice after relief of pressure overload. Conclusion Sac/Val exerted its beneficial effects to prevent maladaptive cardiac fibrosis and dysfunction in mice following pressure unloading, which was at least partly due to the inhibition of NLRP3 inflammasome activation.

show abstract

Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement

Cited by 63 publications

References 27 publications

Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Ramipril in High-Risk Patients With COVID-19

Protection of Sacubitril/Valsartan against Pathological Cardiac Remodeling by Inhibiting the NLRP3 Inflammasome after Relief of Pressure Overload in Mice

Contact Info

Product

Resources

About