Prognostic influence of acute decompensated heart failure in patients planned for transcatheter aortic valve implantation

Abstract

Objective The aim of our study was to evaluate the outcome of patients with severe aortic stenosis presenting with acute decompensated heart failure (ADHF) and planned for transcatheter aortic valve implantation (TAVI) and to study the variables influencing their prognosis. Methods Our retrospective study included 801 patients planned for TAVI in our center. Seven hundred and fifty‐six underwent TAVI and were categorized according to ADHF as the initial clinical presentation into two groups: ADHF group (n = 261) and no‐ADHF group (n = 495). Pre as well as periprocedural outcomes and 1 year mortality were analyzed. Results Among the patients planned for the TAVI procedure, 45 patients remained untreated: 35 patients died while waiting to undergo TAVI which represented 20% of all deaths in our study, ADHF was observed in 23 of 45 (51%) these untreated patients. The 1‐year all‐cause mortality rate was significantly higher in the ADHF group versus the no‐ADHF group (27% vs. 15%, p < .0001). In multivariate analysis, male gender (odds ratio [OR] =2.5, 95% confidence interval [CI]: 1.37–4.57, p = .03), body mass index <25 kg/m2 (OR = 2.76, 95% CI: 1.51–5.04, p = .0009), and logistic EuroSCORE II ≥20% (OR = 3.04, 95% CI: 1.56–5.94, p = .001) were associated with a higher 1‐year mortality in the ADHF group. Conclusion The patients eligible for TAVI presenting with ADHF were associated with a higher mortality for both: while on the waiting list for TAVI as well as at 1‐year follow‐up and thus asking for clearer criteria to prioritize action in this high‐risk TAVI patients.

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

“…There were 22 studies 92–113 (178,002 participants) with cardiovascular populations (Table S3): 7 cohorts in Europe, 6 in North America, 5 in East Asia, 2 were international cohorts, and 1 each West Asia and the Pacific. Mean age of participants ranged from 37 to 83 years.…”

Acute advanced aortic stenosis

“…Typical signs and symptoms of HF are consistently reported and include dyspnea (categorized as NYHA functional class ≥ 3), pulmonary edema, need for intravenous diuretic administration, paroxysmal nocturnal dyspnea, lower limb edema, X-ray signs of pulmonary congestion, pulmonary rales, jugular vein distension, and hepatomegaly. The prevalence of these conditions ranges from 9 to 60% [8][9][10][11][12].…”

Transcatheter aortic valve replacement after heart failure hospitalization: too little, too late?

“…Similarly, in a retrospective cohort from France, TAVR recipients presenting with acute HF had more post‐procedural acute renal failure and requirement for inotropic support, and significantly higher mortality both at 30 days (10% vs. 5%, P = 0.02) and at 1 year (27% vs. 15%, P < 0.001) compared to stable patients 7 . Importantly, acute HF was widely prevalent (>50%) in patients with AS on the TAVR waitlist who were untreated 7 . This finding is consistent with contemporary reports of high rates of hospitalization for HF among untreated patients with AS 8 …”

“…In the FinnValve registry, recent acute HF was associated with lower 30‐day and 5‐year survival, more post‐procedural complications (including acute renal failure), and higher rates of healthcare resource utilization in both the SAVR and TAVR groups 2 . Similarly, in a retrospective cohort from France, TAVR recipients presenting with acute HF had more post‐procedural acute renal failure and requirement for inotropic support, and significantly higher mortality both at 30 days (10% vs. 5%, P = 0.02) and at 1 year (27% vs. 15%, P < 0.001) compared to stable patients 7 . Importantly, acute HF was widely prevalent (>50%) in patients with AS on the TAVR waitlist who were untreated 7 .…”

“…Patients with AS who develop HF have suboptimal outcomes after TAVR or SAVR compared to their non‐HF counterparts 3–5 . Acute HF at presentation in TAVR or SAVR candidates is associated with even worse prognosis despite correction of AS 2,6,7 . In the FinnValve registry, recent acute HF was associated with lower 30‐day and 5‐year survival, more post‐procedural complications (including acute renal failure), and higher rates of healthcare resource utilization in both the SAVR and TAVR groups 2 .…”