Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation
PurposeWe sought to assess the prognostic role of the extent of cardiac damage among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).MethodsA staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-day after TAVI. All-cause mortality at 1-year was the primary endpoint of the study. Cerebrovascular accident, myocardial infarction, permanent pacemaker implantation,
... antation, endocarditis and re-hospitalization for all caused were included as secondary endpoints. ResultsAt 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-day 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. ConclusionsAlthough TAVI might be associated with an amelioration of the left ventricular diastolic and right ventricular function, patients with a greater extent of cardiac damage at baseline are at higher risk of mortality at 1-year after the procedure.