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Prognostic impact of cardiac damage staging classification in each aortic stenosis subtype undergoing TAVI

Masaaki Nakase1, Taishi Okuno1, Daijiro Tomii1

  • 1Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|November 10, 2023
PubMed

Insights

Cardiac damage staging accurately predicts mortality risk in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), regardless of AS subtype.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Prognostic value of cardiac damage staging in severe aortic stenosis (AS) across the hemodynamic spectrum is not well-defined.
  • Understanding this value is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To assess the prognostic impact of cardiac damage staging in patients with high-gradient AS (HG-AS) and low-gradient AS (LG-AS) undergoing transcatheter aortic valve implantation (TAVI).

Main Methods:

  • Prospective evaluation of five-year mortality in a TAVI registry.
  • Categorization of cardiac damage into early (stages 0-2) and advanced (stages 3-4) stages.
  • Analysis across HG-AS, classical low-flow (LF) LG-AS, LF LG-AS with preserved ejection fraction (pEF), and normal-flow (NF) LG-AS subtypes.

Main Results:

  • The study included 2,090 patients undergoing TAVI.
  • Advanced cardiac damage was more prevalent in classical LF LG-AS (73.6%) compared to other subtypes.
  • Advanced cardiac damage was consistently associated with significantly higher five-year mortality across all AS subtypes after TAVI (adjusted HRs ranging from 1.49 to 1.69).

Conclusions:

  • Cardiac damage staging classifications effectively stratify mortality risk following TAVI.
  • This stratification is valid irrespective of the specific subtype of severe aortic stenosis.
Abstract

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