Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation

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

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective The persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin 'angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI. Methods Between October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189). Results At 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group ('9±24% vs '2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025). Conclusions 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.

Original languageEnglish
Pages (from-to)644-651
Number of pages8
JournalHeart
Volume104
Issue number8
DOIs
Publication statusPublished - 2018 Apr 1

Fingerprint

Renin-Angiotensin System
Therapeutics
Mortality
Angiotensin Receptor Antagonists
Left Ventricular Hypertrophy
Angiotensin-Converting Enzyme Inhibitors
Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis
Kaplan-Meier Estimate
Prescriptions
Registries
Catheters
Randomized Controlled Trials

Keywords

  • angiotensin receptor blockers
  • angiotensin-converting enzyme inhibitors
  • aortic valve stenosis
  • renin-angiotensin system
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ochiai, T., Saito, S., Yamanaka, F., Shishido, K., Tanaka, Y., Yamabe, T., ... Hayashida, K. (2018). Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation. Heart, 104(8), 644-651. https://doi.org/10.1136/heartjnl-2017-311738

Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation. / Ochiai, Tomoki; Saito, Shigeru; Yamanaka, Futoshi; Shishido, Koki; Tanaka, Yutaka; Yamabe, Tsuyoshi; Shirai, Shinichi; Tada, Norio; Araki, Motoharu; Naganuma, Toru; Watanabe, Yusuke; Yamamoto, Masanori; Hayashida, Kentaro.

In: Heart, Vol. 104, No. 8, 01.04.2018, p. 644-651.

Research output: Contribution to journalArticle

Ochiai, T, Saito, S, Yamanaka, F, Shishido, K, Tanaka, Y, Yamabe, T, Shirai, S, Tada, N, Araki, M, Naganuma, T, Watanabe, Y, Yamamoto, M & Hayashida, K 2018, 'Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation', Heart, vol. 104, no. 8, pp. 644-651. https://doi.org/10.1136/heartjnl-2017-311738
Ochiai T, Saito S, Yamanaka F, Shishido K, Tanaka Y, Yamabe T et al. Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation. Heart. 2018 Apr 1;104(8):644-651. https://doi.org/10.1136/heartjnl-2017-311738
Ochiai, Tomoki ; Saito, Shigeru ; Yamanaka, Futoshi ; Shishido, Koki ; Tanaka, Yutaka ; Yamabe, Tsuyoshi ; Shirai, Shinichi ; Tada, Norio ; Araki, Motoharu ; Naganuma, Toru ; Watanabe, Yusuke ; Yamamoto, Masanori ; Hayashida, Kentaro. / Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation. In: Heart. 2018 ; Vol. 104, No. 8. pp. 644-651.
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abstract = "Objective The persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin 'angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI. Methods Between October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189). Results At 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group ('9±24{\%} vs '2±25{\%}, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5{\%} vs 12.5{\%}; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95{\%} CI 0.22 to 0.91; p=0.025). Conclusions 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.",
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T1 - Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation

AU - Ochiai, Tomoki

AU - Saito, Shigeru

AU - Yamanaka, Futoshi

AU - Shishido, Koki

AU - Tanaka, Yutaka

AU - Yamabe, Tsuyoshi

AU - Shirai, Shinichi

AU - Tada, Norio

AU - Araki, Motoharu

AU - Naganuma, Toru

AU - Watanabe, Yusuke

AU - Yamamoto, Masanori

AU - Hayashida, Kentaro

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N2 - Objective The persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin 'angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI. Methods Between October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189). Results At 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group ('9±24% vs '2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025). Conclusions 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.

AB - Objective The persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin 'angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI. Methods Between October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189). Results At 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group ('9±24% vs '2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025). Conclusions 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.

KW - angiotensin receptor blockers

KW - angiotensin-converting enzyme inhibitors

KW - aortic valve stenosis

KW - renin-angiotensin system

KW - transcatheter aortic valve replacement

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