Cardiac damage and outcome in transcatheter aortic valve replacement patients

Abstract Background The extent of cardiac damage (CD) impacts the prognosis of aortic stenosis (AS) patients, however, non-AS related comorbidities may also lead to CD. Purpose This study aimed to investigate the prognostic role of stage 3 and 4 CD after transcatheter aortic valve intervention (TAVI), dependent on whether or not comorbidities were present. Methods Patients without previous aortic valve replacement or more than moderate aortic regurgitation were included from the COMPARE-TAVI 1 trial. Stage 3-4 CD was defined as pulmonary artery systolic pressure ≥ 60 mmHg, ≥ moderate tricuspid regurgitation or tricuspid annulus plane systolic excursion 16 mm. AS-related CD was defined as stage 3-4 CD patients without the presence of concomitant chronic obstructive pulmonary disease, ≥ moderate mitral annular calcification or mitral stenosis, severe mitral regurgitation or previous coronary artery bypass graft surgery; comorbidity-related CD was defined as stage 3-4 CD with the presence of one or more of these comorbidities. Based on this patient were divided in three groups: Stage 0-2 CD, AS-related stage 3-4 CD and comorbidity-related stage 3-4 CD. Futility was defined as death or stage 3-4 NYHA class dyspnea one year after TAVI. Results Of 985 included patients, 98 (10%) had AS-related CD and 65 (7%) had comorbidity-related CD. A futile course was not more common in stage 3-4 CD groups, regardless of whether comorbidities were present (CD 0-2: 10.2%, AS-related CD 3-4: 16.3%, comorbidity related CD 3-4: 15.4%, p=0.10). One-year mortality was highest in AS-related CD (Same order as above: 5.7 vs 11.2 vs 1.5%, p=0.03). Baseline and one-year follow-up NYHA class was higher in higher CD classes (p0.01, figure 1). Six-minute walk test distance increased similarly to one year in all groups (As above: +53±74 vs +47±58 vs +85±88 m, p=0.10, figure 2). Tricuspid gradient decreased more to one year among patients in higher CD classes (As above: -2±11 vs -8±16 vs -9±13 mmHg, p0.0001). Conclusions Potential comorbidities contributing to right ventricular dysfunction or pulmonary hypertension were common among patients in stage 3-4 CD undergoing TAVI. Stage 3-4 CD was not associated with a higher risk of a futile course, irrespective of comorbidities, and although NYHA class remained higher in these patients after TAVI, they experienced a similar increase in 6MWT and a larger reduction in tricuspid gradient.Changes in NYHA after TAVI Changes in 6MWT after TAVI