Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI. The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis, and re-hospitalization for all causes. (3) Results: At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-days after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p = 0.08). No differences were found in secondary endpoints. (4) Conclusions: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure.

Cardiac Damage and Conduction Disorders after Transcatheter Aortic Valve Implantation

“…As a result, the rate of PPMI was the highest in advanced ASCDS stages with 27.3% in group 3, 10% in group 2 compared to 6% in group 1. In a retrospective study assessing prognostic impact of ASCDS in 262 patients, the rate of PPMI did not differ between groups 0/1, 2, 3 and 4 [27]. In this study, the distribution of patients within each ASCDS category differed from our study and the staging criteria used were slightly different.…”

“…The more severe the extra-valvular lesions, the more the outcome is compromised with a progressive increase in mortality for each stage increment [14,15]. The prognostic value of this staging system was subsequently tested in populations with severe AS undergoing TAVI, also showing an increase in mortality with the extent of cardiac damage [27,28]. However, to the best of our knowledge, the correlation between ASCDS and ECG changes after TAVI has never been studied.…”

Prognostic Value of Non-Invasive Global Myocardial Work in Asymptomatic Aortic Stenosis

“…Currently, the main triggers for intervention in patients with AS and preserved LVEF are the presence of AS-related symptoms and the severity of AS [ 1 ], mainly assessed by Doppler echocardiographic data [ 7 ]. However, current evidence on increased mortality in moderate AS patients raised some concerns on the strict classification of the disease based only on valve haemodynamics, suggesting that a more complete evaluation, also integrating markers of cardiac injury or metabolic distress could promptly detect patients that would benefit from of an early AVR intervention [ 2 , 20 ]. The staging cardiac scheme, which includes myocardial structural changes, haemodynamics parameters, and indices of myocardial dysfunction (including GLS), has demonstrated a strong predictive value in asymptomatic moderate-to-severe AS patients [ 4 ].…”

Echocardiographic Evaluation after Transcatheter Aortic Valve Implantation: A Comprehensive Review

“…A significant improvement in RV function has been described as early as 24 h after TAVI [ 62 ] and confirmed at mid-term follow-up with the increase in TAPSE and FAC values [ 63 ].…”