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Wang S, Lin X, Guan Y, Huang J. The clinical outcomes of reni-angiotensin system inhibitors for patients after transcatheter aortic valve replacement: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:963731. [PMID: 36035924 PMCID: PMC9402980 DOI: 10.3389/fcvm.2022.963731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
AimsThe objective of our systematic reviews and meta-analysis is to evaluate the clinical outcomes of RAS inhibitors for patients after TAVR.Methods and resultsWe performed a comprehensive search for Embase, Pubmed, and Cochrane databases from inception to May 1, 2022. The analysis of all outcomes was performed using the random-effects model. In total, 7 articles with a total of 32,585 patients (RAS inhibitor, N = 14,871; Controls, N = 17,714) were included in our study. There was a significantly lower rates of all-cause mortality (RR = 0.76, 95%Cl = 0.68 to 0.86, P < 0.01), cardiovascular death (RR = 0.66, 95%Cl = 0.59–0.74, P < 0.01) and HF readmission (RR = 0.87, 95%Cl = 0.80–0.94, P < 0.01) in patients with RAS inhibitors compared with controls. Patients with RAS inhibitors also had lower rates of all-cause mortality (RR = 0.82, 95%Cl = 0.76–0.89, P < 0.01) and cardiovascular death (RR = 0.73, 95%Cl, 0.62–0.85, P < 0.01) after propensity matching.ConclusionsIn conclusion, our systematic reviews and meta-analysis demonstrated that RAS inhibitors could improve the clinical outcomes for patients after TAVR. Further large and high-quality trials should be conducted to support the use of RAS inhibitors for patients after TAVR.
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Affiliation(s)
- Shuai Wang
- Department of Translation Medicine Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Shuai Wang
| | - Xiaoxiao Lin
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yihong Guan
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinyu Huang
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Jinyu Huang
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Al Balool J, Al Jarallah M, Rajan R, Dashti R, Alasousi N, Kotevski V, Taha Mousa AS, Al Haroun R, Tse G, Zhanna KD, Setiya P, Saber AA, Brady PA. Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction: A single centre pilot study. Ann Med Surg (Lond) 2022; 77:103712. [PMID: 35638043 PMCID: PMC9142703 DOI: 10.1016/j.amsu.2022.103712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction To define baseline echocardiographic, electrocardiographic (ECG) and computed tomographic (CT) findings of patients with heart failure undergoing transcatheter aortic valve replacement (TAVR) and analyze their overall procedural outcomes. Methods Between 2018 and 2021, patients with severe aortic stenosis (AS) who performed transcatheter aortic valve replacement (TAVR) in Sabah Al Ahmad Cardiac Centre, Al Amiri Hospital were identified. A retrospective review of patients' parameters including pre-, intra-, and post-procedural data was conducted. Patients were grouped in 2 subgroups according to their EF: EF <40% (HFrEF) and EF ≥ 40%. The data included patients’ baseline characteristics, electrocardiographic and echocardiographic details along with pre-procedural CT assessment of aortic valve dimensions. Primary outcomes including post-operative disturbances, pacemaker implantation and in-hospital mortality following TAVR were additionally analyzed. Results A total of 61 patients with severe AS underwent TAVR. The mean age was 73.5 ± 9, and 21 (34%) of the patients were males. The mean ejection fraction (EF) was 55.5 ± 9.7%. Of 61 patients, 12 (20%) were identified as heart failure with reduced EF (<40%). These patients were younger, more often males, and were more likely to have coronary artery disease (75% versus 53.1%). Left ventricular hypertrophy and diastolic dysfunction was documented in 75% and 58.3% of patients with heart failure with reduced ejection fraction (HFrEF) respectively. Post TAVR conduction disturbances, with the commonest being LBBB was observed in 41.7%. Permanent pacemaker was implanted in 3 of patients with HFrEF (25%). There were no significant differences between the two groups with regards to in hospital mortality (p = 0.618). Conclusion Severe AS with EF <40% constitute a remarkable proportion of patients undergoing TAVR. Preliminary results of post-operative conduction disturbances and in hospital mortality in HFrEF patients were concluded to not differ from patients with LVEF ≥40%. This is the first reported outcome study of TAVR in patients with heart failure in Kuwait. Conduction disturbances induced by TAVR was observed in almost half of the patients. Systolic dysfunction was not a predictor of in hospital complications or mortality outcomes.
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Affiliation(s)
- Joud Al Balool
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Corresponding author. Department of Medicine, Faculty of Medicine, Kuwait University, China.
| | - Mohammed Al Jarallah
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Raja Dashti
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Nader Alasousi
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Vladimir Kotevski
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Ahmed Said Taha Mousa
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Retaj Al Haroun
- Department of Medicine, Royal College of Surgeons, Dublin, Ireland
| | - Gary Tse
- Cardiovascular Analytics Group, Hong Kong, China: Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Parul Setiya
- Department of Agrometeorology, College of Agriculture, G.B.Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
| | - Ahmad Al Saber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK
| | - Peter A. Brady
- Department of Cardiology, Illinois Masonic Medical Center, Chicago IL, USA
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