Hopfgarten Johan, James Stefan, Lindhagen Lars, Baron Tomasz, Ståhle Elisabeth, Christersson Christina
Department of Medical Sciences, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden.
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Eur Heart J Open. 2024 May 9;4(3):oeae039. doi: 10.1093/ehjopen/oeae039. eCollection 2024 May.
There is a lack of robust data on the optimal medical treatment of heart failure in patients with severe aortic stenosis, with no randomized controlled trials guiding treatment. The study aimed to study the association between exposure to renin-angiotensin-aldosterone system (RAS) inhibitors or beta-blockers and outcome after aortic valve replacement in patients with aortic stenosis and heart failure.
The study included all patients with heart failure undergoing aortic valve replacement for aortic stenosis in Sweden between 2008 and 2016 ( = 4668 patients). Exposure to treatment was assessed by a continuous tracking of drug dispensations, and outcome events were all-cause mortality and hospitalization for heart failure collected from national patient registries. After adjustment for age, sex, atrial fibrillation, hypertension, diabetes mellitus, and prior myocardial infarction, Cox regression analysis showed that RAS inhibition was associated with a lower risk of all-cause mortality in patients with reduced left ventricular ejection fraction (LV-EF) [hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51-0.65] and preserved LV-EF (HR 0.69, 95% CI 0.56-0.85). Beta-blockade was associated with a lower risk of all-cause mortality in patients with reduced LV-EF (HR 0.81, 95% CI 0.71-0.92), but not in preserved LV-EF (HR 0.87, 95% CI 0.69-1.10). There was no association between RAS inhibition or beta-blockade and the risk of hospitalization for heart failure.
The RAS inhibition was associated with a lower all-cause mortality after valve replacement in patients with both reduced and preserved LV-EF. Beta-blockade was associated with lower all-cause mortality only in patients with reduced LV-EF.
对于重度主动脉瓣狭窄患者心力衰竭的最佳药物治疗，目前缺乏有力数据，且尚无随机对照试验指导治疗。本研究旨在探讨肾素 - 血管紧张素 - 醛固酮系统（RAS）抑制剂或β受体阻滞剂的使用与主动脉瓣狭窄合并心力衰竭患者主动脉瓣置换术后结局之间的关联。
本研究纳入了2008年至2016年期间在瑞典因主动脉瓣狭窄接受主动脉瓣置换术的所有心力衰竭患者（n = 4668例）。通过持续跟踪药物配给来评估治疗暴露情况，结局事件为全因死亡率和从国家患者登记处收集的心力衰竭住院率。在对年龄、性别、心房颤动、高血压、糖尿病和既往心肌梗死进行校正后，Cox回归分析显示，RAS抑制与左心室射血分数（LV-EF）降低的患者全因死亡率较低相关[风险比（HR）0.58，95%置信区间（CI）0.51 - 0.65]以及LV-EF保留的患者（HR 0.69，95% CI 0.56 - 0.85）。β受体阻滞剂与LV-EF降低的患者全因死亡率较低相关（HR 0.81，95% CI 0.71 - 0.92），但与LV-EF保留的患者无关（HR 0.87，95% CI 0.69 - 1.10）。RAS抑制或β受体阻滞剂与心力衰竭住院风险之间无关联。
RAS抑制与LV-EF降低和保留患者瓣膜置换术后较低的全因死亡率相关。β受体阻滞剂仅与LV-EF降低的患者较低的全因死亡率相关。
