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).
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.
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).
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.
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.