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Whether restoring hemodynamics through HT or LVAD implantation sufficiently resolves neurohormonal activation remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with end-stage heart failure undergoing HT or LVAD implantation were enrolled in a prospective registry. NT-proBNP, plasma active renin concentration (ARC), aldosterone levels, and the complete profile of angiotensin metabolites were assessed before and after the intervention in 49 HT and 12 LVAD recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The use of RAS inhibitors was significantly reduced after HT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and remained comparable in LVAD patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.453). Both HT and LVAD were associated with reductions in NTproBNP (3015 to 1140\u00a0pg\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 8980 to 1836\u00a0pg\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) and ARC levels (278 to 87\u00b5IU\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 847 to 131 \u00b5IU\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.074), which was accompanied by a decrease in the angiotensin burden of the classical RAS axis (AngI\u2009+\u2009AngII: 159 to 47\u00a0ng\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 214 to 42\u00a0ng\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.155). However, no patient showed normalization of NT-proBNP levels. Additionally, plasma renin remained elevated in 76% of HT and 67% of LVAD recipients, accompanied by detectable Ang II levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Continuing AngII spill-over after HT and LVAD may affect patient outcomes, potentially contributing to complications. The findings support the rationale for cardioprotective treatment, particularly with RAS inhibitors, in most patients, while further studies should address the long-term effect of this strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>HT\u2014heart transplantation, RAS\u2014renin-angiotensin system, LVAD\u2014left ventricular assist device. 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