Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers After Transcatheter Aortic

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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

Published on: June 3, 2018

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Vivek Bhat1, Ashish Kumar2, Ankur Kalra3,4

  • 1Department of Internal Medicine, St. John's Medical College, Bangalore, India.

JACC. Advances
|June 28, 2024
PubMed

Insights

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) use after transcatheter aortic valve replacement (TAVR) is associated with reduced all-cause mortality and new-onset atrial fibrillation. Further randomized trials are needed to establish definitive guidelines for ACEIs/ARBs post-TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Persistent left ventricular hypertrophy post-transcatheter aortic valve replacement (TAVR) is linked to adverse outcomes.
  • Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may improve ventricular remodeling and outcomes after TAVR.
  • Current guidelines lack recommendations on ACEI/ARB use post-TAVR.

Purpose of the Study:

  • To compare clinical outcomes in patients receiving ACEIs/ARBs versus those not receiving them after TAVR.
  • To evaluate the impact of ACEIs/ARBs on mortality and other adverse events post-TAVR.

Main Methods:

  • A systematic literature search was conducted on PubMed and Cochrane Library up to June 14, 2023.
  • Included studies compared clinical outcomes between patients on ACEIs/ARBs and those not on these medications post-TAVR.
  • All-cause mortality was the primary outcome, analyzed using a random effects model.

Main Results:

  • Ten studies were included. Patients on ACEIs/ARBs showed a significantly lower risk of all-cause mortality (RR: 0.74) and cardiovascular mortality (RR: 0.70).
  • A reduced risk of new-onset atrial fibrillation was observed in patients taking ACEIs/ARBs (RR: 0.71).
  • No significant differences were found in risks of myocardial infarction, heart failure, stroke, pacemaker implantation, acute kidney injury, bleeding, vascular complications, or valvular regurgitation.

Conclusions:

  • ACEI/ARB use post-TAVR is associated with improved survival and reduced incidence of new-onset atrial fibrillation.
  • The risk of other major adverse events remains comparable between groups.
  • Randomized clinical trials are warranted to confirm these findings and inform guideline development for ACEI/ARB therapy post-TAVR.
Abstract

Keywords:
aortic stenosisrenin-angiotensin-aldosterone systemstructural heart diseasevalve implantation

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