Valvular & structural heart diseaseRandomised controlled trial
Effect of renin-angiotensin system inhibition on left ventricular mass regression after transcatheter aortic valve replacement: a randomised controlled trial
- multicentre, prospective, randomised, open-label, blinded-endpoint trial
- randomly assigned (1:1)
- modified intention-to-treat analysis
Authors' conclusion
In patients with heart failure and LVEF ≥40% following TAVR, RAS inhibition led to enhanced reverse LV remodelling over 12 months, reflected by greater regression of LV mass and volumes. These findings support the potential role for RASi in modifying post-TAVR myocardial remodelling, although larger trials are required to determine whether these structural benefits translate into improved clinical outcomes.
Study context
- Population
- Patients aged ≥60 years with symptomatic severe aortic stenosis, LV ejection fraction (LVEF) ≥40% and successful transcatheter aortic valve replacement (TAVR)randomised, 194 included in the modified intention-to-treat analysis · renin-angiotensin system inhibitors (RASi) 95 · control 99
- Participants
- 200 patients
- Comparison
- standard care plus RASi vs standard care alone
- RASin = 95
- controln = 99
- Primary endpoint
- Change in LV mass index (LVMI)
- Follow-up
- 12 months
Primary result
As reported in the abstract
Adjusted mean difference
−12.77 g/m²
95% CI −24.73 to −0.81
P = 0.036
Secondary outcomes
Left ventricular (LV) end-diastolic and end-systolic volumes
- Consistent improvements were observed in LV end-diastolic and end-systolic volumes
Functional status (New York Heart Association class)
- improved modestly in the RASi group
LVEF and NT-proBNP
- No significant differences were observed in LVEF or NT-proBNP
Original publication
Summarised from the published abstract; every number is checked against it