Frontiers in Cardiovascular Medicine (Dec 2022)

The impact of extra-valvular cardiac damage on mid-term clinical outcome following transcatheter aortic valve replacement in patients with severe aortic stenosis

  • Costanza Pellegrini,
  • Charlotte Duesmann,
  • Tobias Rheude,
  • Amelie Berg,
  • Hector A. Alvarez-Covarrubias,
  • Teresa Trenkwalder,
  • N. Patrick Mayr,
  • Friederike Schürmann,
  • Philipp Nicol,
  • Erion Xhepa,
  • Michael Joner,
  • Michael Joner

DOI
https://doi.org/10.3389/fcvm.2022.1039208
Journal volume & issue
Vol. 9

Abstract

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AimsTo quantify extra-valvular cardiac damage associated with severe aortic valve stenosis (AS), a novel staging model was proposed. This study aimed to validate this model in patients undergoing transcatheter aortic valve replacement (TAVR) as well as to assess its prognostic impact.Methods and resultsBased on echocardiographic findings, the following stages were applied: isolated AS (stage 0), left ventricular (LV) damage (stage 1), left atrial or mitral valve damage (stage 2), pulmonary hypertension or tricuspid regurgitation (stage 3), or right ventricular dysfunction (stage 4). The primary endpoint was 2-year all-cause mortality. The distribution across stages was 0.8% at stage 0, 7.5% at stage 1, 63.3% at stage 2, 18.3% at stage 3, and 10.1% at stage 4. All-cause mortality increased at all stages 1–4 (12.1%, 18.2%, 26.6%, and 28.2%; p = 0.023). In the multivariate model, the stage of cardiac damage, age, New York Heart Association (NYHA) class III/IV, peripheral artery disease, and previous pacemaker were independent predictors of the primary endpoint.ConclusionsPatients treated for severe AS show a high prevalence of extra-valvular cardiac damage. An increase in stage is associated with higher 2-year all-cause mortality. The application of this staging model may add value to current treatment algorithms.

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