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Valvular heart disease
Original research article
Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation
  1. Tomoki Ochiai1,
  2. Shigeru Saito1,
  3. Futoshi Yamanaka1,
  4. Koki Shishido1,
  5. Yutaka Tanaka1,
  6. Tsuyoshi Yamabe2,
  7. Shinichi Shirai3,
  8. Norio Tada4,
  9. Motoharu Araki5,
  10. Toru Naganuma6,
  11. Yusuke Watanabe7,
  12. Masanori Yamamoto8,9,
  13. Kentaro Hayashida10
  1. 1 Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
  2. 2 Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
  3. 3 Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
  4. 4 Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
  5. 5 Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
  6. 6 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
  7. 7 Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
  8. 8 Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
  9. 9 Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
  10. 10 Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
  1. Correspondence to Dr Tomoki Ochiai, Department of Cardiology, Shonan Kamakura General Hospital 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan; tomoki.ochiai.0307{at}gmail.com

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.

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

https://doi.org/10.1136/heartjnl-2017-311738

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    Footnotes

    • Contributors TO, SS (SS), FY, KS, YT: conception, design, analysis and interpretation of data; drafting of the manuscript and critically revising it for important intellectual content and final approval of the submitted manuscript. TY, SS (SS), NT, MA, TN, YW, MY, KH: drafting of the manuscript and critically revising it for important intellectual content and final approval of the submitted manuscript.

    • Competing interests Drs SS, MY, NT, TN, MA, SS, YW and KH are proctors for Edwards Lifesciences (transfemoral-TAVI with SAPIEN-XT valves).

    • Ethics approval The medical ethics committee of each participating hospital approved the study protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice This article has been corrected since it was published Online First. In the "Changes in lV mass index" section the values "(18±29% vs. 4±25%, p=0.66)" have been changed to "(-18±29% vs. 4±25%, p=0.066)". In tables 1 and 4 the rows ’Male sex' have also been updated.

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