{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T14:42:56Z","timestamp":1777300976092,"version":"3.51.4"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,5,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">We evaluated the potential benefits of renin\u2010angiotensin\u2010aldosterone system inhibitors (RAASi) in patients with left ventricular assist device support.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A total of 165 consecutive patients undergoing left ventricular assist device implant and alive at 6\u2010month on support were studied. RAASi status after 6\u2010month visit along with clinical reasons for nonprescription\/uptitration were retrospectively assessed. The primary outcome was a composite of heart failure hospitalization or cardiovascular death between 6 and 24\u2009months after left ventricular assist device implant. Remodeling and hemodynamic outcomes were explored by studying the association of RAASi new prescription\/uptitration versus unmodified therapy at 6\u2010month visit with the change in echocardiographic parameters and hemodynamics between 6 and 18\u2009months. After the 6\u2010month visit, 76% of patients were on RAASi. Patients' characteristics among those receiving and not receiving RAASi were mostly similar. Of 85 (52%) patients without RAASi new prescription\/uptitration at 6\u2010month visit, 62% had no apparent clinical reason. RAASi were independently associated with the primary outcome (adjusted hazard ratio, 0.31 [95% CI, 0.16\u20130.69]). The baseline rates of optimal echocardiographic profile (neutral interventricular septum, mitral regurgitation less than mild, and aortic valve opening) and hemodynamic profile (cardiac index \u22652.2\u2009L\/min per m\n              <jats:sup>2<\/jats:sup>\n              , wedge pressure &lt;18\u2009mm\u2009Hg, and right atrial pressure &lt;12\u2009mm\u2009Hg) were similar between groups. At 18\u2009months, patients receiving RAASi new prescription\/uptitration at 6\u2009months had higher rates of optimal hemodynamic profile (57.5% versus 37.0%;\n              <jats:italic>P<\/jats:italic>\n              =0.032) and trends for higher rates of optimal echocardiographic profile (39.6% versus 22.9%;\n              <jats:italic>P<\/jats:italic>\n              =0.055) compared with patients with 6\u2010month unmodified therapy. Optimal 18\u2010month hemodynamic and echocardiographic profiles were associated with the primary outcome (log\u2010rank=0.022 and log\u2010rank=0.035, respectively).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">RAASi are associated with improved outcomes and improved hemodynamics among mechanically unloaded patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032617","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T11:32:15Z","timestamp":1714476735000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Association of Renin\u2010Angiotensin\u2010Aldosterone System Inhibitors With Clinical Outcomes, Hemodynamics, and Myocardial Remodeling Among Patients With Advanced Heart Failure on Left Ventricular Assist Device Support"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8011-6844","authenticated-orcid":false,"given":"Guglielmo","family":"Gallone","sequence":"first","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"},{"name":"Division of Cardiology, Cardiovascular and Thoracic Department Citt\u00e0 della Salute e della Scienza Hospital Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4293-2570","authenticated-orcid":false,"given":"Javier","family":"Ibero","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Morley\u2010Smith","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2086-8718","authenticated-orcid":false,"given":"Maria","family":"Monteagudo Vela","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4403-8863","authenticated-orcid":false,"given":"Mailen","family":"Konicoff","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Edwards","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7112-9809","authenticated-orcid":false,"given":"Binu","family":"Raj","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8036-6253","authenticated-orcid":false,"given":"Mayooran","family":"Shanmuganathan","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2105-7693","authenticated-orcid":false,"given":"Stefano","family":"Pidello","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department Citt\u00e0 della Salute e della Scienza Hospital Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2977-3299","authenticated-orcid":false,"given":"Simone","family":"Frea","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department Citt\u00e0 della Salute e della Scienza Hospital Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano Maria","family":"De Ferrari","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department Citt\u00e0 della Salute e della Scienza Hospital Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9894-9200","authenticated-orcid":false,"given":"Vasileios","family":"Panoulas","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"},{"name":"Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2497-258X","authenticated-orcid":false,"given":"Ulrich","family":"Stock","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4811-435X","authenticated-orcid":false,"given":"Christopher","family":"Bowles","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1251-3826","authenticated-orcid":false,"given":"John","family":"Dunning","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Riesgo Gil","sequence":"additional","affiliation":[{"name":"Cardiothoracic Transplantation Harefield Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation 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