Cardiac Damage and Clinical Outcomes in Symptomatic Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.
Researchers
Akihiro Tobe, Michele Gallazzi, Niels van Royen, Ignacio J Amat-Santos, Martin Hudec, Matjaz Bunc, Ben J L Van den Branden, Peep Laanmets, Daniel Unic, Bela Merkely, Renicus S Hermanides, Vlasis Ninios, Marcin Protasiewicz, Benno J W M Rensing, Pedro L Martin, Fausto Feres, Manuel De Sousa Almeida, Eric van Belle, Axel Linke, Alfonso Ielasi, Matteo Montorfano, Mark Webster, Konstantinos Toutouzas, Emmanuel Teiger, Francesco Bedogni, Michiel Voskuil, Manuel Pan, Oskar Angerås, Won-Keun Kim, Jürgen Rothe, Mohamed Abdel-Wahab, Ivica Kristić, Vicente Peral, Scot Garg, Ashokkumar Thakkar, Udita Chandra, Pieter C Smits, Daniele Andreini, Philippe Généreux, Marie-Claude Morice, Andreas Baumbach, Patrick W Serruys, Yoshinobu Onuma
Abstract
The extent of cardiac damage in patients with aortic stenosis (AS) is associated with worse clinical outcomes.
This study sought to investigate the clinical impact of cardiac damage using the updated criteria incorporating the echocardiographic probability of pulmonary hypertension.
This post hoc subanalysis of LANDMARK trial, which randomized 768 patients with severe AS to the Myval transcatheter heart valve (THV) series or to contemporary THVs (Sapien and Evolut series), used updated cardiac damage classification: stage 0, no cardiac damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary artery or tricuspid valve damage; and stage 4, right ventricular damage. The impact of cumulative cardiac damage, defined as meeting all criteria for stages 1 to 4, was also assessed. The primary endpoint was 1-year all-cause mortality.
Cardiac damage stages were assessed in 596 patients (stage 0, n = 36; stage 1, n = 88; stage 2, n = 284; stage 3, n = 84; stage 4, n = 104), with a mean age of 80.2 (5.7) years and a mean Society of Thoracic Surgeons score of 3.3% (2.4%). One-year mortality was 0%, 1.1%, 4.7%, 7.2%, and 20.4% in stages 0, 1, 2, 3, and 4, respectively (log-rank P < 0.001). The area under the curve for predicting 1-year mortality was 0.739. Patients with cumulative cardiac damage had the highest mortality (23.6%). In the multivariable analysis, stage 4 was independently associated with higher 1-year mortality.
The updated cardiac damage staging stratified 1-year mortality after transcatheter aortic valve replacement, highlighting the importance of comprehensive echocardiographic assessment in severe AS. (LANDMARK Trial: a Randomised Controlled Trial of Myval THV [LANDMARK]; NCT04275726).