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Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR

Background: Morbidity and mortality following trans-catheter aortic valve replacement (TAVR) remain high. Renin-angiotensin system inhibitors improve clinical outcomes in the cohort studied in this work. However, post-TAVR prognostic impact of mineralocorticoid receptor antagonist (MRA), another neu...

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Autores principales: Imamura, Teruhiko, Narang, Nikhil, Onoda, Hiroshi, Tanaka, Shuhei, Ushijima, Ryuichi, Sobajima, Mitsuo, Fukuda, Nobuyuki, Ueno, Hiroshi, Kinugawa, Koichiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253895/
https://www.ncbi.nlm.nih.gov/pubmed/37297936
http://dx.doi.org/10.3390/jcm12113742
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author Imamura, Teruhiko
Narang, Nikhil
Onoda, Hiroshi
Tanaka, Shuhei
Ushijima, Ryuichi
Sobajima, Mitsuo
Fukuda, Nobuyuki
Ueno, Hiroshi
Kinugawa, Koichiro
author_facet Imamura, Teruhiko
Narang, Nikhil
Onoda, Hiroshi
Tanaka, Shuhei
Ushijima, Ryuichi
Sobajima, Mitsuo
Fukuda, Nobuyuki
Ueno, Hiroshi
Kinugawa, Koichiro
author_sort Imamura, Teruhiko
collection PubMed
description Background: Morbidity and mortality following trans-catheter aortic valve replacement (TAVR) remain high. Renin-angiotensin system inhibitors improve clinical outcomes in the cohort studied in this work. However, post-TAVR prognostic impact of mineralocorticoid receptor antagonist (MRA), another neuro-hormonal blocker, remains uncertain. Here, we hypothesized that MRA was associated with improved clinical outcomes in elderly patients with severe aortic stenosis receiving TAVR. Methods: Consecutive patients who received TAVR at our institute between 2015 and 2022 were considered for inclusion. Propensity score matching analysis was performed to match pre-procedural baseline characteristics between those with and without MRA. The prognostic impact of MRA use on the composite primary endpoint consisting of all-cause death and heart failure during the 2-year observational period following index discharge was evaluated. Results: Among 352 patients who received TAVR, 112 patients (median 86 years, 31 men) were included, consisting of baseline-matched 56 patients with MRA and 56 patients without MRA. Following TAVR, patients with MRA had more impaired renal function compared with no MRA group. Following index discharge, serum potassium tended to increase, and renal function tended to decline in patients with MRA. Patients with MRA had a higher cumulative incidence of the primary endpoints during a two-year observational period (30% versus 8%, p = 0.022). Conclusions: Routine prescription of MRA might not be recommended in elderly patients with severe aortic stenosis receiving TAVR, given its negative prognostic impact. Optimal patient selection for MRA administration in this cohort needs further study.
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spelling pubmed-102538952023-06-10 Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR Imamura, Teruhiko Narang, Nikhil Onoda, Hiroshi Tanaka, Shuhei Ushijima, Ryuichi Sobajima, Mitsuo Fukuda, Nobuyuki Ueno, Hiroshi Kinugawa, Koichiro J Clin Med Article Background: Morbidity and mortality following trans-catheter aortic valve replacement (TAVR) remain high. Renin-angiotensin system inhibitors improve clinical outcomes in the cohort studied in this work. However, post-TAVR prognostic impact of mineralocorticoid receptor antagonist (MRA), another neuro-hormonal blocker, remains uncertain. Here, we hypothesized that MRA was associated with improved clinical outcomes in elderly patients with severe aortic stenosis receiving TAVR. Methods: Consecutive patients who received TAVR at our institute between 2015 and 2022 were considered for inclusion. Propensity score matching analysis was performed to match pre-procedural baseline characteristics between those with and without MRA. The prognostic impact of MRA use on the composite primary endpoint consisting of all-cause death and heart failure during the 2-year observational period following index discharge was evaluated. Results: Among 352 patients who received TAVR, 112 patients (median 86 years, 31 men) were included, consisting of baseline-matched 56 patients with MRA and 56 patients without MRA. Following TAVR, patients with MRA had more impaired renal function compared with no MRA group. Following index discharge, serum potassium tended to increase, and renal function tended to decline in patients with MRA. Patients with MRA had a higher cumulative incidence of the primary endpoints during a two-year observational period (30% versus 8%, p = 0.022). Conclusions: Routine prescription of MRA might not be recommended in elderly patients with severe aortic stenosis receiving TAVR, given its negative prognostic impact. Optimal patient selection for MRA administration in this cohort needs further study. MDPI 2023-05-29 /pmc/articles/PMC10253895/ /pubmed/37297936 http://dx.doi.org/10.3390/jcm12113742 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Imamura, Teruhiko
Narang, Nikhil
Onoda, Hiroshi
Tanaka, Shuhei
Ushijima, Ryuichi
Sobajima, Mitsuo
Fukuda, Nobuyuki
Ueno, Hiroshi
Kinugawa, Koichiro
Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR
title Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR
title_full Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR
title_fullStr Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR
title_full_unstemmed Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR
title_short Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR
title_sort negative prognostic impact of mineralocorticoid receptor antagonist in elderly patients receiving tavr
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253895/
https://www.ncbi.nlm.nih.gov/pubmed/37297936
http://dx.doi.org/10.3390/jcm12113742
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