Author + information
- Received April 8, 2019
- Revision received May 8, 2019
- Accepted May 14, 2019
- Published online July 29, 2019.
- Tania Rodriguez-Gabella, MDa,
- Pablo Catalá, MDa,
- Antonio J. Muñoz-García, MD, PhDb,
- Luis Nombela-Franco, MD, PhDc,
- Raquel Del Valle, MD, PhDd,
- Enrique Gutiérrez, MD, PhDe,
- Ander Regueiro, MD, PhDf,
- Victor A. Jimenez-Diaz, MD, PhDg,
- Henrique B. Ribeiro, MD, PhDh,
- Fernando Rivero, MD, PhDi,
- Jose Antonio Fernandez-Diaz, MD, PhDj,
- Philippe Pibarot, MD, PhDk,
- Juan H. Alonso-Briales, MD, PhDb,
- Gabriela Tirado-Conte, MD, PhDc,
- César Moris, MD, PhDd,
- Felipe Diez Del Hoyo, MDe,
- Gustavo Jiménez-Britez, MDg,
- Nicolas Zaderenko, MD, PhDh,
- Fernando Alfonso, MD, PhDi,
- Itziar Gómez, MScl,
- Manuel Carrasco-Moraleja, MDl,
- Josep Rodés-Cabau, MD, PhDk,
- J. Alberto San Román Calvar, MD, PhDa,l and
- Ignacio J. Amat-Santos, MD, PhDa,l,∗ (, )@ignamatsant
- aCardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- bCIBERCV, Cardiology Department, Hospital Virgen de la Victoria, Málaga, Spain
- cCardiology Department, Hospital Clínico San Carlos, Madrid, Spain
- dCardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- eCIBERCV, Cardiology Department, Hospital Gregorio Marañon, Madrid, Spain
- fCIBERCV, Cardiology Department, Hospital Clinic, Barcelona, Spain
- gCIBERCV, Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain
- hInstituto do Coraçao (InCor), São Paulo, Brazil
- iCardiology Department, Hospital La Princesa, Madrid, Spain
- jCIBERCV, Cardiology Department, Hospital Puerta de Hierro, Madrid, Spain
- kQuebec Heart & Lung Institute, Quebec City, Quebec, Canada
- lCIBERCV, Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- ↵∗Address for correspondence:
Dr. Ignacio J. Amat Santos, Cardiology Department, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón, Ramon y Cajal, 3, 47005 Valladolid, Spain.
Background Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis and myocardial hypertrophy has been related to worse prognosis.
Objectives The aim of this study was to explore the potential benefits of renin-angiotensin system (RAS) inhibitors on left ventricular remodeling and major clinical outcomes following successful transcatheter aortic valve replacement (TAVR).
Methods Patients from 10 institutions with severe aortic stenosis who underwent TAVR between August 2007 and August 2017 were included. All baseline data were prospectively recorded, and pre-specified follow-up was performed. Doses and types of RAS inhibitors at discharge were recorded, and matched comparison according to their prescription at discharge was performed.
Results A total of 2,785 patients were included. Patients treated with RAS inhibitors (n = 1,622) presented similar surgical risk scores but a higher rate of all cardiovascular risk factors, coronary disease, and myocardial infarction. After adjustment for these baseline differences, reduction of left ventricular volumes and hypertrophy was greater and cardiovascular mortality at 3-year follow-up was lower (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.87; p = 0.007) in patients treated with RAS inhibitors. Moreover, RAS inhibitors demonstrated a global cardiovascular protective effect with significantly lower rates of new-onset atrial fibrillation, cerebrovascular events, and readmissions.
Conclusions Post-TAVR RAS inhibitors are associated with lower cardiac mortality at 3-year follow-up and offer a global cardiovascular protective effect that might be partially explained by a positive left ventricular remodeling. An ongoing randomized trial will help confirm these hypothesis-generating findings. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185)
This project was supported by Insituto de Salud Carlos III (grant PI17/02237). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received April 8, 2019.
- Revision received May 8, 2019.
- Accepted May 14, 2019.
- 2019 American College of Cardiology Foundation
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