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Cardio-hepatic syndrome in patients undergoing transcatheter aortic valve replacement

Lukas Stolz1, Michael Kirchner1, Julius Steffen1

  • 1Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|June 19, 2023
PubMed

Insights

Cardiohepatic syndrome (CHS), prevalent in 22% of TAVR patients, significantly predicts worse three-year survival. Identifying CHS is crucial for TAVR decision-making and improving patient outcomes.

Area of Science:

  • Cardiology
  • Hepatology
  • Transcatheter Aortic Valve Replacement (TAVR)

Background:

  • Cardiohepatic syndrome (CHS) is an underrecognized predictor of survival in cardiovascular diseases.
  • Its prevalence and prognostic impact in TAVR for severe aortic stenosis (AS) require evaluation.

Purpose of the Study:

  • To assess the prevalence of CHS in patients undergoing TAVR for severe AS.
  • To determine the prognostic value of CHS regarding survival, technical outcomes, and functional status post-TAVR.

Main Methods:

  • A cohort of 953 patients undergoing TAVR with available hepatic function parameters were analyzed.
  • CHS was defined by elevated bilirubin, alkaline phosphatase, or gamma-glutamyl transferase.
  • Outcomes included 3-year survival, VARC-3 defined technical/device failure, and NYHA functional class.

Main Results:

  • CHS was present in 22.4% of patients (n=212).
  • Technical and device failure rates were similar between CHS and non-CHS groups.
  • Patients with CHS had more severe NYHA class and significantly lower 3-year survival (49.4% vs. 65.4%, p<0.001).
  • CHS remained an independent predictor of mortality (HR 1.58, p<0.01).

Conclusions:

  • CHS is prevalent in 22% of TAVR patients for severe AS.
  • CHS is associated with worse 3-year survival and more severe heart failure symptoms.
  • Incorporating CHS assessment into TAVR heart team decision-making is recommended.
Abstract

Keywords:
Aortic stenosisCardiohepatic syndromeCongestionHeart failureLiver functionTAVR

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