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

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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.

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Data availability

The dataset generated and analyzed during the current study is available in the Biological Specimen and Data Repository Information Coordinating Center [14].

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Acknowledgements

The authors thank the INTERMACS investigators, coordinators, and participating institutions for the data they provided for this registry. This manuscript was prepared using the INTERMACS research materials obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center and does not necessarily reflect the opinions or views of INTERMACS or the NHLBI.

Funding

This study was not funded.

Author information

Author notes

  1. Gianmarco Lombardi and Alessia Gambaro have equally contributed to the article.

Authors and Affiliations

  1. U.O.C. Nefrologia, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy

    Gianmarco Lombardi & Giovanni Gambaro

  2. U.O.C. Cardiologia, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy

    Alessia Gambaro & Flavio Luciano Ribichini

  3. U.O.S. Terapia Conservativa della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italia

    Pietro Manuel Ferraro

  4. Università Cattolica del Sacro Cuore, Rome, Italia

    Pietro Manuel Ferraro

Authors
  1. Gianmarco Lombardi
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  2. Alessia Gambaro
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  3. Flavio Luciano Ribichini
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  4. Pietro Manuel Ferraro
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  5. Giovanni Gambaro
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Contributions

GL, AG, and GG contributed to the research idea and study design. GL contributed to data acquisition. GL and PMF contributed to data analysis and interpretation. PMF and GL contributed to statistical analysis. GL and AG. drafted the paper. GG, PMF, and FLR contributed to supervision. Each author contributed important intellectual content during manuscript drafting of the overall work.

Corresponding author

Correspondence to Gianmarco Lombardi.

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Conflict of ineterest

PMF: consultant fees from Allena Pharmaceuticals, Alnylam, BioHealth Italia, Vifor Fresenius. All the other authors report no conflicts of interest.

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Lombardi, G., Gambaro, A., Ribichini, F.L. et al. RAS inhibitors and renal and general mortality in patients with heart failure supported by left ventricular assist devices: a registry study. Clin Res Cardiol 112, 891–900 (2023). https://doi.org/10.1007/s00392-022-02136-6

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  • DOI: https://doi.org/10.1007/s00392-022-02136-6

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