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Related Concept Videos

Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...

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Eccentric hypertrophy impairs outcome after TAVR.

R Thalmann1, V Obermeier1,2, Dominik S Westphal3,4,5

  • 1Klinik Und Poliklinik Für Innere Medizin I, University Hospital Rechts Der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|December 9, 2024
PubMed
Summary

Patients with eccentric hypertrophy (EH) after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) face higher mortality. Genetic factors, measured by polygenic risk scores (PRS), may influence these cardiac remodeling patterns.

Keywords:
CardiomyopathyHypertrophyOutcomePolygenic risk scoreTAVRTranscatheter aortic valve replacement

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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.