Eccentric hypertrophy impairs outcome after TAVR.

Area of Science:

• Cardiology
• Genetics
• Cardiac Surgery

Background:

• Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to cardiac remodeling.
• Understanding varying LV hypertrophy patterns is crucial for predicting outcomes after transcatheter aortic valve replacement (TAVR).
• Genetic predisposition may influence the development of different hypertrophy patterns.

Purpose of the Study:

• To analyze clinical outcomes of symptomatic AS patients undergoing TAVR based on distinct LV hypertrophy patterns.
• To investigate the genetic influence on these hypertrophy patterns using polygenic risk scores (PRS).

Main Methods:

• Retrospective analysis of 1703 patients with severe AS undergoing TAVR.
• Categorization into four LV geometry subgroups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).
• Substudy analysis of 520 patients using two PRS associated with hypertrophic and dilated cardiomyopathy.

Main Results:

• Patients with eccentric hypertrophy (EH) showed significantly higher all-cause mortality at 1 year (17.4%) and 4 years (41.9%) post-TAVR compared to NG, CR, and CH groups.
• Higher PRS percentiles for hypertrophic cardiomyopathy were associated with a reduced likelihood of developing EH.
• The EH group demonstrated poorer clinical outcomes up to 5 years post-TAVR.

Conclusions:

• Eccentric hypertrophy is associated with significantly worse outcomes in patients with aortic stenosis undergoing TAVR.
• Polygenic risk scores show potential for predicting myocardial responses to AS and guiding future therapeutic strategies.