High dosage RAS blockade linked to improved survival after TAVR, finds study

Angiotensin-converting enzyme inhibitors (ACEIs) have been widely prescribed worldwide and have been associated with a reduction in cardiovascular mortality in a large range of patients with cardiovascular disease, and in patients at risk for negative cardiovascular outcomes.

Though a growing body of evidence from retrospective studies has suggested that the renin-angiotensin system (RAS) blockade is associated with improved outcome after transcatheter aortic valve replacement (TAVR), however, it remains unknown whether the effect of RAS blockade is dose-dependent.

The present study by Jakob Ledwoch et al, at the Technical University of Munich, Munich, sought to assess the dose-dependent effect of RAS blockade on survival and left ventricular (LV) remodeling after TAVR.

The study design consisted of Patients who were enrolled into the observational TAVR study at the institution and were retrospectively assessed according to different dosed of RAS blockade: Group 1 (no RAS blockade), group 2 (25% of maximum daily dose), group 3 (50% of maximum daily dose) and group 4 (full daily dose).

Results revealed the following key facts.

• A total of 323 patients between January 2015 and September 2019 were included.
• Patients with higher doses of RAS blockade showed a trend towards higher overall survival at 3-year follow-up (56% with no RAS blockade vs. 66% with the 25% dose vs. 79% with the 50% dose vs. 78% with the full dose; p=0.063).
• After adjustment for baseline characteristics, the difference in survival was significant (p=0.042).
• Besides NYHA class and left ventricular ejection fraction (LV-EF) RAS blockade dose was identified as independent predictor for all-cause mortality (HR 0.72 [95% CI 0.54-0.97]; p=0.03).
• Concerning LV remodeling, a significantly larger reduction of LV mass index was observed during the follow-up with higher doses of RAS blockade.

On closely observing the results, the authors concluded that "The present study showed that the impact of RAS blockade treatment on clinical outcome and LV remodeling after TAVR is dose-dependent."

For full article follow the link: DOI:https://doi.org/10.1016/j.cjca.2020.08.014

Primary source: Canadian Journal of Cardiology