Echocardiographic effects of an angiotensin receptor-neprilysin inhibitor after transcatheter aortic valve implantation: a substudy of a randomized trial
S Okita, H Kitahara, K Miyakoda, H Yaginuma, H Yamamoto, T Kanda, K Makiko, H Sasaki, N Suzuki-Eguchi, H Takaoka, K Matsuura, G Matsumiya, Y KobayashiAbstract
Background
Heart failure (HF) frequently occurs after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), even following an apparently successful procedure. Although angiotensin receptor-neprilysin inhibitor (ARNI) therapy improves outcomes in selected HF populations, its effects on cardiac function after TAVI remain unclear.
Purpose
To evaluate whether the addition of ARNI to conventional medical therapy improves echocardiographic parameters after TAVI.
Methods
This exploratory echocardiographic substudy was conducted within a prospective, single-center, open-label, randomized, parallel-group trial. Patients undergoing TAVI were randomized in a 1:1 ratio to receive either conventional therapy alone (control group) or conventional therapy plus ARNI (ARNI group). In the ARNI group, medication was initiated on postoperative day 1 or 2, uptitrated as tolerated, and continued for at least the 6 months. Transthoracic echocardiography was performed at baseline and at 6 months after TAVI. Between-group differences in 6-month left ventricular ejection fraction (LVEF), LV mass index (LVMi), tricuspid regurgitation pressure gradient (TRPG), left atrial volume index (LAVi), and the ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e') were assessed using analysis of covariance adjusted for the corresponding baseline value.
Results
A total of 77 patients were analyzed (control, n=39; ARNI, n=38). After adjustment for baseline TRPG, TRPG at 6 months was significantly lower in the ARNI group than in the control group (adjusted difference [ARNI minus control], -4.30 mmHg; 95% CI -7.83 to -0.82; p=0.017). Baseline-adjusted 6-month values of LVEF, LAVi, LVMi, and E/e' did not differ significantly between the 2 groups (Figure).
Conclusions
In this exploratory echocardiographic substudy, early initiation of ARNI after TAVI was associated with reduction in TRPG at 6 months after adjustment for baseline TRPG, whereas other echocardiographic indices did not show clear between-group differences.Figure