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Published on: August 8, 2025
Cardiac damage and outcome in transcatheter aortic valve replacement patients-a COMPARE-TAVI 1 trial sub-study
Rasmus Carter-Storch1, Christian Juhl Terkelsen2,3, Henrik Nissen1
1Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, Odense C 5000, Denmark.
Insights
Severe cardiac damage (stage 3-4) after transcatheter aortic valve intervention (TAVI) did not increase futility risk, even with comorbidities. Patients showed similar functional improvements post-TAVI, regardless of cardiac damage stage or comorbidities.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Transcatheter aortic valve intervention (TAVI) is a key treatment for severe aortic stenosis (AS).
- Cardiac damage (CD) staging is crucial for prognosis after TAVI.
- The impact of advanced CD (stage 3-4) on TAVI outcomes, especially with comorbidities, requires further investigation.
Purpose of the Study:
- To evaluate the prognostic significance of stage 3-4 cardiac damage (CD) following TAVI.
- To determine if comorbidities influencing right heart function modify the prognosis of advanced CD after TAVI.
Main Methods:
- Retrospective analysis of 985 patients undergoing TAVI for severe AS.
- Patients categorized into: CD stage 0-2; CD stage 3-4 with isolated AS; CD stage 3-4 with comorbidities.
- Futility defined as death or NYHA class 3-4 dyspnea at one year post-TAVI.
Main Results:
- 83% had CD stage 1-2, 10% had CD stage 3-4 isolated AS, and 6% had CD stage 3-4 with comorbidities.
- Futility rates were similar across groups (10% vs. 17% vs. 15%, p=0.09).
- Baseline and one-year NYHA class was higher in stage 3-4 CD groups (p<0.01), but 6-minute walking test distance improved similarly.
Conclusions:
- Comorbidities affecting right heart function are frequent in patients with stage 3-4 CD undergoing TAVI.
- Stage 3-4 CD is not associated with increased futility risk after TAVI, irrespective of comorbidities.
- Patients with advanced CD experience comparable functional gains post-TAVI to those with less severe CD.
Aims:
This study aims to investigate the prognostic role of Stage 3 and 4 cardiac damage (CD) after transcatheter aortic valve intervention (TAVI), dependent on whether comorbidities contributing to right heart dysfunction were present.
Methods And Results:
Patients with severe aortic stenosis (AS) undergoing TAVI were included. Patients were divided into three groups: Stage 0-2 CD; Stage 3-4 CD, isolated AS (Stage 3-4 CD without significant concomitant chronic obstructive pulmonary disease, mitral annular calcification, mitral stenosis, mitral regurgitation, previous coronary artery bypass graft surgery, or cardiac amyloidosis); Stage 3-4 CD, AS with comorbidities (Stage 3-4 CD with ≥ 1 of these comorbidities). Futility was defined as death or Stage 3-4 New York Heart Association class dyspnoea 1 year after TAVI.Of 985 included patients, 822 (83%) had Stage 1-2 CD; 101 (10%) had Stage 3-4 CD, isolated AS; and 62 (6%) had Stage 3-4 CD, AS with comorbidities. Futility was not more common in Stage 3-4 CD groups (Stage 1-2 CD, 10%; Stage 3-4 CD, isolated AS, 17%; Stage 3-4 CD, AS with comorbidities, 15%, P = 0.09). Baseline and 1-year NYHA class were higher in Stage 3-4 CD compared with Stage 1-2 CD (P < 0.01). The 6 min walking test distance increased similarly in all groups at 1 year.
Conclusion:
Potential comorbidities contributing to right heart dysfunction were common among patients in Stage 3-4 CD undergoing TAVI. Stage 3-4 CD was not associated with a significantly higher risk of futility, irrespective of comorbidities, and they experienced a similar functional improvement after TAVI.
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