The Reversibility of Cardiac Damage After Transcatheter Aortic Valve Implantation and Short-Term Outcomes in a Real-World Setting.

Abstract

Aims: This study aims to assess the changes in cardiac damage stage in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI) and to investigate the prognostic value of cardiac damage stage evolution.

Methods and results: Patients with severe AS undergoing TAVI were retrospectively analyzed. A 5-stage system based on the presence and extent of cardiac damage assessed by echocardiography was applied before and 6 months after TAVI. Multivariable Cox regression analyses were used to examine independent prognostic value of the changes in cardiac damage after TAVI. A total of 734 patients with severe AS (mean age 79.8±7.4 years, 55% male) were included. Before TAVI, 32 (4%) patients did not show any sign of extra-valvular cardiac damage (Stage 0), 85 (12%) had left ventricular damage (Stage 1), 220 (30%) left atrial and/or mitral valve damage (Stage 2), 227 (31%) pulmonary vasculature and/or tricuspid valve damage (Stage 3), and 170 (23%) right ventricular damage (Stage 4). Six months after TAVI, 39% of the patients improved at least 1 stage in cardiac damage. Staging of cardiac damage at 6 months after TAVI (HR per 1-stage increase 1.391; P = 0.035) as well as worsening in the stage of cardiac damage (HR 3.729, P = 0.005) were independently associated with 2-year all-cause mortality.

Conclusion: More than one third of patients with severe AS showed an improvement in cardiac damage 6 months after TAVI. Staging cardiac damage at baseline and follow-up may improve risk stratification in patients undergoing TAVI.