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Neuroendocrine inhibition in patients with heart failure and severe aortic stenosis undergoing TAVI
Authors : J E Pino (Atlantis,US), F Ramos Tuarez (Atlantis,US), P Torres (Atlantis,US), K Chen (Atlantis,US), M Kabach (Atlantis,US), A Alrifai (Atlantis,US), L Lovitz (Atlantis,US), R Cubeddu (Atlantis,US), M Rothemberg (Atlantis,US), R Chait (Atlantis,US), M Nores (Atlantis,US)
J E Pino1
,
F Ramos Tuarez1
,
P Torres1
,
K Chen1
,
M Kabach1
,
A Alrifai1
,
L Lovitz1
,
R Cubeddu2
,
M Rothemberg2
,
R Chait1
,
M Nores2
,
1University of Miami/ JFK Medical Center, Cardiovascular Disease - Atlantis - United States of America
,
2JFK Medical Center - Atlantis - United States of America
,
Topic(s): Chronic Heart Failure – Treatment
Background:
Neuroendocrine inhibition with beta-blockers (BBs) and renin-angiotensin system inhibitor (RAS-i) has been postulated to decrease morbidity and mortality in patients with heart failure and reduced ejection fraction. However, there is inconclusive data about the role of BBs and RAS-I in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
Purpose:
We aim to demonstrate that BBs and RAS-i will decrease morbidity and mortality in patients with severe AS after the left ventricular outflow obstruction has been resolved with TAVI.
Methods
This is a retrospective cohort study of patients with severe AS that underwent TAVI between April 2012 and March 2016 in a tertiary cardiovascular center. The presence of neuroendocrine inhibition with BBs, RAS-i or both (BBs +RAS-i) was assessed. Evaluated outcomes included 30-day and 1-year mortality, length of stay, acute kidney injury (AKI), stroke and heart failure readmission (one month).
Results
Out of the 372 patients that underwent TAVI in our institution, 158 (42%) were female with a mean age of 84.9 ± 6.7 years and mean STS score of 6.93 ± 4.01. A total of 127 (34%) patients had heart failure with reduced ejection fraction, 291(78%) had hypertension, and 79(21%) had diabetes mellitus. Their mean creatinine was 1.13-±0.58 mg/dl, mean AV-area was 0.65 ± 0.17 cm2 and mean AV-gradient was 49.4 ± 13.2 mmHg. A transfemoral approach was performed in 261 (70%) of the patients. Neuroendocrine inhibition was present in 324 (87%) patients, of these, 284 (76.3%) were on BBs, 151 (41%) were on RAS-i, and 111 (30%) were on BBs + RAS-i. See Table 1 for clinically relevant outcomes.
Conclusions
This study suggests that neuroendocrine inhibition with RAS-i is associated with lower hospital stay and 30-day mortality in patients with severe AS and heart failure undergoing TAVI. The rate of post-TAVI AKI was not affected by the presence of RAS-i. Beta-blockers failed to demonstrate any significant outcome.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
