Fouzi Alnour; Bo  E. Beuthner; Samy Hakroush; Rodi Topci; Anja Vogelgesang; Torben Lange; Tim Seidler; Ingo Kutschka; Karl Toischer; Andreas Schuster; Claudius Jacobshagen; Andreas Leha; Markus Zabel; Gerd Hasenfuß; Miriam Puls; Elisabeth  M. Zeisberg

doi:10.4244/EIJ-D-23-01068

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Original Research

DOI: 10.4244/EIJ-D-23-01068

Cardiac fibrosis as a predictor for sudden cardiac death after transcatheter aortic valve implantation

Fouzi Alnour¹^,², MD; Bo E. Beuthner¹^,², MD; Samy Hakroush³, MD; Rodi Topci¹^,², MD; Anja Vogelgesang¹^,², MD; Torben Lange¹^,², MD; Tim Seidler¹^,², MD; Ingo Kutschka⁴, MD; Karl Toischer¹^,², MD; Andreas Schuster¹^,², MD, PhD; Claudius Jacobshagen¹^,²^,⁵, MD; Andreas Leha⁶, MD; Markus Zabel¹^,², MD; Gerd Hasenfuß¹^,², MD; Miriam Puls¹^,², MD; Elisabeth M. Zeisberg¹^,², MD

Abstract

BACKGROUND: Cardiac fibrosis plays a major pathophysiological role in any form of chronic heart disease, and high levels are associated with poor outcome. Diffuse and focal cardiac fibrosis are different subtypes, which have different pathomechanisms and prognostic implications. The total fibrosis burden in endomyocardial biopsy tissue was recently proved to play an independent prognostic role in aortic stenosis patients after transcatheter aortic valve implantation (TAVI).

AIMS: Here, for the first time, we aim to assess the specific impact of different fibrosis subtypes on sudden cardiac death (SCD) as a primary reason for cardiovascular mortality after TAVI.

METHODS: The fibrosis pattern was assessed histologically in the left ventricular biopsies obtained during TAVI interventions in 161 patients, who received a structured follow-up thereafter.

RESULTS: Receiver operating characteristic analyses, performed 6, 12, 24 and 48 months after TAVI, showed diffuse, but not focal, fibrosis as a significant predictor for SCD at all timepoints, with the highest area under the curve at the first time point and a decrease in its SCD predictivity over time. In both multivariate Cox proportional hazards and...

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