RAS inhibitors and renal and general mortality in patients with heart failure supported by left ventricular assist devices: a registry study.

Pubmed ID: 36459185

Journal: Clinical research in cardiology : official journal of the German Cardiac Society

Publication Date: July 1, 2023

MeSH Terms: Humans, Heart Failure, Treatment Outcome, Prospective Studies, Kidney, Antineoplastic Agents, Registries, Heart-Assist Devices

Authors: Lombardi G, Gambaro A, Ribichini FL, Ferraro PM, Gambaro G

Cite As: Lombardi G, Gambaro A, Ribichini FL, Ferraro PM, Gambaro G. RAS inhibitors and renal and general mortality in patients with heart failure supported by left ventricular assist devices: a registry study. Clin Res Cardiol 2023 Jul;112(7):891-900. Epub 2022 Dec 2.

Studies:

Abstract

BACKGROUND: The aim of our study was to analyze the association between renin-angiotensin system inhibitor (RASi) therapy and renal outcomes and mortality in patients with heart failure (HF) supported by left ventricular assist device (LVAD) using a large, nationwide prospective cohort. To date, no studies have comprehensively analyzed the association between RASi and renal outcomes and mortality in patients with HF supported by LVAD. METHODS: We performed a retrospective observational study on LVAD patients in the Interagency Registry for Mechanically Assisted Circulatory Support. The main outcome was a composite of renal event and all-cause mortality. Secondary outcomes were the individual components of the composite outcome. A renal event was defined as a composite of doubling serum creatinine, eGFR decrease ≥ 40%, or need for dialysis. The exposure of interest was RASi therapy, updated during follow-up. Cox regression models adjusted for potential confounders were used to estimate the association between time-updated RASi therapy and the outcomes of interest. RESULTS: The analysis included 6448 patients. During a median follow-up of 12.7 months (IQR 19.8 months), 1632 patients developed the composite outcome. RASi therapy was associated with a lower risk of developing the composite outcome (HR 0.61, 95% CI 0.55, 0.68, P < 0.001). A significant association was confirmed between RASi therapy and renal outcomes (HR 0.74, 95% CI 0.61, 0.89, P = 0.002) and all-cause mortality (HR 0.56, 95% CI 0.50, 0.63, P < 0.001). CONCLUSIONS: Our data suggest a beneficial role of RASi therapy on renal function and all-cause mortality in patients with HF supported by LVAD.