■经导管主动脉瓣置换术(TAVR)后持续左心室肥厚与不良预后相关。血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB),由于它们对心室重构的有利影响,已经被假设为改善TAVR后的结果,然而,没有关于他们的使用建议。
■本研究旨在比较接受ACEI/ARB和未接受ACEI/ARB的患者在TAVR后的结局。
我们在PubMed和Cochrane图书馆进行了文献检索,直到2023年6月14日,包括所有比较TAVR后接受ACEI/ARB和未接受ACEI/ARB的患者临床结果的研究。全因死亡率是主要结果。我们使用具有适当校正的随机效应模型来计算相对风险(RR)和CI,所有分析都使用Rv4.0.3进行。
■我们纳入了10项关于TAVR后ACEI/ARB使用的研究。ACEI/ARBs患者全因死亡率风险较低(RR:0.74,95%CI:0.65-0.86,I2=62%,卡方P<0.01),心血管死亡率(RR:0.70,95%CI:0.56-0.88,I2=0%,卡方P=0.54),和新发房颤(RR:0.71,95%CI:0.52-0.96,I2=0%,卡方P=0.59)。ACEI/ARBs患者有类似的心肌梗死风险,心力衰竭,中风,新的永久性起搏器植入,急性肾损伤,大出血,血管并发症,主动脉瓣反流,和二尖瓣反流.
■我们发现接受ACEI/ARBs的患者全因死亡风险较低,心血管死亡率,和新发心房颤动。其他结局的风险与未接受ACEI/ARBs的患者相似。需要随机临床试验来探索TAVR后ACEI/ARBs的益处,这样就可以制定明确的指导方针。
UNASSIGNED: Persistent left ventricular hypertrophy after transcatheter aortic valve replacement (TAVR) has been associated with poor outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), due to their favorable effects on ventricular remodeling, have been hypothesized to improve outcomes post-TAVR, yet there are no recommendations regarding their use.
UNASSIGNED: This study aimed to compare the outcomes of patients receiving ACEIs/ARBs with those not receiving ACEIs/ARBs after TAVR.
UNASSIGNED: We performed a literature search on PubMed and Cochrane Library until June 14, 2023, and included all studies comparing clinical outcomes between patients given ACEIs/ARBs and those not given ACEIs/ARBs after TAVR. All-cause mortality was the primary outcome. We used a random effects model with appropriate corrections to calculate relative risk (RR) and CIs, with all analyses carried out using R v4.0.3.
UNASSIGNED: We included ten studies on the use of ACEIs/ARBs post-TAVR. Patients on ACEIs/ARBs had lower risk of all-cause mortality (RR: 0.74, 95% CI: 0.65-0.86, I2 = 62%, chi-square P < 0.01), cardiovascular mortality (RR: 0.70, 95% CI: 0.56-0.88, I2 = 0%, chi-square P = 0.54), and new-onset atrial fibrillation (RR: 0.71, 95% CI: 0.52-0.96, I2 = 0%, chi-square P = 0.59). Patients on ACEIs/ARBs had a similar risk of myocardial infarction, heart failure, stroke, new permanent pacemaker implantation, acute kidney injury, major bleeding, vascular complications, aortic regurgitation, and mitral regurgitation.
UNASSIGNED: We found that patients receiving ACEIs/ARBs had a lower risk of all-cause mortality, cardiovascular mortality, and new-onset atrial fibrillation. Risk of other outcomes was similar to patients not receiving ACEIs/ARBs. Randomized clinical trials are needed to explore the benefits of ACEIs/ARBs post-TAVR, so that definitive guidelines can be developed.