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Neuroendocrine inhibition in patients with heart failure and severe aortic stenosis undergoing TAVI

Session Poster Session 2

Speaker Jesus E Pino Moreno

Congress : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure - Treatment
  • Session type : Poster Session
  • FP Number : P1033

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)

Authors:
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 ,

Citation:

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.

Beta-blockers

RAS-inhibitors RAS-i plus beta-blockers

Yes

(284)

NO

(88)
p-value

Yes

(151)

NO

(221)
p-value

Yes

(111)

No

(261)
p-value
30-day mortality 12 (4.23) 6 (6.82) 0.391 3 (1.99) 15 (6.7) *0.046 2 (1.8) 16 (6.13) 0.110
1-year mortality 52(18.3) 16(18.2) 1.000 25 (16.5) 43 (19.5) 0.498 19 (17.1) 49 (18.7) 0.770
Length of stay 7.5± 4.2 7.8±4.9 0.730 7.2±3.8 7.8±4.7 0.163 6.9± 2.5 7.8 ± 5.0 *0.013
Acute Kidney Injury 63 (22.3) 20 (22.7) 1.000 29 (19.3) 54 (24.4) 0.256 23 (21.0) 60 (23.0) 0.685
Stroke 3 (3.4) 13 (4.5) 0.770 3 (1.99) 13 (5.88) 0.074 3 (2.7) 13 (5.0) 0.411
30-day readmission (HF) 3 (3.37) 12 (4.23) 1.000 3 (2) 12 (5.4) 0.111 3 (2.7) 12 (4.6) 0.567
HF (Heart Failure)

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