RT Journal Article
T1 Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement.
A1 Rodriguez-Gabella, Tania
A1 Catalá, Pablo
A1 Muñoz-García, Antonio J
A1 Nombela-Franco, Luis
A1 Del Valle, Raquel
A1 Gutiérrez, Enrique
A1 Regueiro, Ander
A1 Jimenez-Diaz, Victor A
A1 Ribeiro, Henrique B
A1 Rivero, Fernando
A1 Fernandez-Diaz, Jose Antonio
A1 Pibarot, Philippe
A1 Alonso-Briales, Juan H
A1 Tirado-Conte, Gabriela
A1 Moris, César
A1 Diez Del Hoyo, Felipe
A1 Jiménez-Britez, Gustavo
A1 Zaderenko, Nicolas
A1 Alfonso, Fernando
A1 Gómez, Itziar
A1 Carrasco-Moraleja, Manuel
A1 Rodés-Cabau, Josep
A1 San Román Calvar, J Alberto
A1 Amat-Santos, Ignacio J
K1 RAS inhibitors
K1 TAVR
K1 fibrosis
K1 hypertrophy
AB 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. 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). 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. 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. 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).
YR 2019
FD 2019
LK http://hdl.handle.net/10668/14354
UL http://hdl.handle.net/10668/14354
LA en
DS RISalud
RD Apr 11, 2025