Relation Between Renin-Angiotensin System Blockers and Survival Following Isolated Aortic Valve Replacement for Aortic Stenosis

Magné, Julien; Guinot, Barthélémy; Guyader, Alexandre Le; Bégot, Emmanuelle; Marsaud, Jean-Philippe; Mohty, Dania; Aboyans, Victor

doi:10.1016/j.amjcard.2017.11.013

Cited by 20 publications

(23 citation statements)

References 19 publications

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“…This finding is particularly important in the clinical scenario and for confirming the rational use of ACE inhibitor or Ang II receptor blockers following elective aortic valve replacement surgery. Magne et al [22], in an observational study, demonstrated that the use of these inhibitors was associated with improved long-term outcomes after isolated surgical aortic valve replacement. Although we do not have experimental evidence due to a lack of spatiotemporal inhibition of TN-C, it is tempting to speculate that remaining higher TN-C expression after debanding surgery may contribute to and explain higher ACE activity in cardiac tissue as compared to control hearts.…”

Section: Discussionmentioning

confidence: 99%

The Role of Tenascin C in Cardiac Reverse Remodeling Following Banding–Debanding of the Ascending Aorta

Perera-Gonzalez

Kiss

Kaiser

et al. 2021

IJMS

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Background: Tenascin-C (TN-C) plays a maladaptive role in left ventricular (LV) hypertrophy following pressure overload. However, the role of TN-C in LV regression following mechanical unloading is unknown. Methods: LV hypertrophy was induced by transverse aortic constriction for 10 weeks followed by debanding for 2 weeks in wild type (Wt) and TN-C knockout (TN-C KO) mice. Cardiac function was assessed by serial magnetic resonance imaging. The expression of fibrotic markers and drivers (angiotensin-converting enzyme-1, ACE-1) was determined in LV tissue as well as human cardiac fibroblasts (HCFs) after TN-C treatment. Results: Chronic pressure overload resulted in a significant decline in cardiac function associated with LV dilation as well as upregulation of TN-C, collagen 1 (Col 1), and ACE-1 in Wt as compared to TN-C KO mice. Reverse remodeling in Wt mice partially improved cardiac function and fibrotic marker expression; however, TN-C protein expression remained unchanged. In HCF, TN-C strongly induced the upregulation of ACE 1 and Col 1. Conclusions: Pressure overload, when lasting long enough to induce HF, has less potential for reverse remodeling in mice. This may be due to significant upregulation of TN-C expression, which stimulates ACE 1, Col 1, and alpha-smooth muscle actin (α-SMA) upregulation in fibroblasts. Consequently, addressing TN-C in LV hypertrophy might open a new window for future therapeutics.

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Section: Discussionmentioning

confidence: 99%

The Role of Tenascin C in Cardiac Reverse Remodeling Following Banding–Debanding of the Ascending Aorta

Perera-Gonzalez

Kiss

Kaiser

et al. 2021

IJMS

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“…In recent years, several trials have been performed to assess the effects of a postoperative RAAS blockade on clinical outcomes. Post-AVR treatment has been associated with improved long-term outcomes [114] and a lower risk of all-cause and CV mortality [115,116]. The global cardiovascular protective effect might be partially explained by a positive LV remodeling; a randomized trial (ARISTOTE, NCT03315832) is ongoing to confirm this hypothesis [117].…”

Section: Future Perspectivesmentioning

confidence: 99%

Current Evidence and Future Perspectives on Pharmacological Treatment of Calcific Aortic Valve Stenosis

Donato

Ferri

Lupo

et al. 2020

IJMS

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Calcific aortic valve stenosis (CAVS), the most common heart valve disease, is characterized by the slow progressive fibro-calcific remodeling of the valve leaflets, leading to progressive obstruction to the blood flow. CAVS is an increasing health care burden and the development of an effective medical treatment is a major medical need. To date, no effective pharmacological therapies have proven to halt or delay its progression to the severe symptomatic stage and aortic valve replacement represents the only available option to improve clinical outcomes and to increase survival. In the present report, the current knowledge and latest advances in the medical management of patients with CAVS are summarized, placing emphasis on lipid-lowering agents, vasoactive drugs, and anti-calcific treatments. In addition, novel potential therapeutic targets recently identified and currently under investigation are reported.

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“…RAAS inhibitors have also been associated with increased survival rates and greater LV mass reduction after surgical [ 56 , 57 ] and transcatheter [ 58 , 59 , 60 ] aortic valve replacement for severe AS.…”

Section: Treatmentmentioning

confidence: 99%

Arterial Hypertension in Aortic Valve Stenosis: A Critical Update

Basile¹,

Fucile²,

Lembo³

et al. 2021

JCM

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Aortic stenosis (AS) is a very common valve disease and is associated with high mortality once it becomes symptomatic. Arterial hypertension (HT) has a high prevalence among patients with AS leading to worse left ventricle remodeling and faster degeneration of the valve. HT also interferes with the assessment of the severity of AS, leading to an underestimation of the real degree of stenosis. Treatment of HT in AS has not historically been pursued due to the fear of excess reduction in afterload without a possibility of increasing stroke volume due to the fixed aortic valve, but most recent evidence shows that several drugs are safe and effective in reducing BP in patients with HT and AS. RAAS inhibitors and beta-blockers provide benefit in selected populations based on their profile of pharmacokinetics and pharmacodynamics. Different drugs, on the other hand, have proved to be unsafe, such as calcium channel blockers, or simply not easy enough to handle to be recommended in clinical practice, such as PDE5i, MRA or sodium nitroprusside. The present review highlights all available studies on HT and AS to guide antihypertensive treatment.

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Relation Between Renin-Angiotensin System Blockers and Survival Following Isolated Aortic Valve Replacement for Aortic Stenosis

Cited by 20 publications

References 19 publications

The Role of Tenascin C in Cardiac Reverse Remodeling Following Banding–Debanding of the Ascending Aorta

The Role of Tenascin C in Cardiac Reverse Remodeling Following Banding–Debanding of the Ascending Aorta

Current Evidence and Future Perspectives on Pharmacological Treatment of Calcific Aortic Valve Stenosis

Arterial Hypertension in Aortic Valve Stenosis: A Critical Update

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