Less Symptom Improvement in Patients Undergoing TAVI With Concomitant COPD, Atrial Fibrillation and Heart Failure

Area of Science:

• Cardiology
• Pulmonology
• Geriatrics

Background:

• Comorbidities like chronic obstructive pulmonary disease (COPD), atrial fibrillation (AF), and heart failure (HF) can mimic aortic stenosis (AS) symptoms.
• The impact of these comorbidities on symptom improvement and long-term outcomes following transcatheter aortic valve implantation (TAVI) remains unclear.

Purpose of the Study:

• To investigate the influence of COPD, AF, and HF on patient outcomes after TAVI.

Main Methods:

• A pooled analysis of three TAVI cohorts (Groningen, Brescia, Bern) was conducted.
• Data on COPD, AF, and HF history were collected.
• Symptom improvement was defined as at least one NYHA class improvement at 12 months.
• Adverse events (cardiovascular mortality, stroke, HF hospitalization) were tracked over 5 years (VARC-3 criteria).

Main Results:

• The study included 5173 patients (mean age 81.5 years).
• Patients with COPD, AF, or HF presented with lower aortic valve gradients, higher cardiac damage, and worse NYHA class pre-TAVI.
• After adjustment, COPD (OR 1.75) and HF (OR 1.65) were linked to no symptom improvement.
• AF did not significantly impact symptom improvement (OR 1.12).
• Patients with COPD, AF, or HF experienced higher risks of adverse events and reduced long-term survival.

Conclusions:

• Symptomatic AS patients with COPD, AF, or HF undergo TAVI with lower AS severity but higher symptomatic burden and cardiac damage.
• These patients have an increased risk of residual symptoms and poorer long-term outcomes.
• COPD and HF specifically are associated with diminished symptom relief post-TAVI.