Prognostic impact of cardiac damage staging classification in each aortic stenosis subtype undergoing TAVI

EuroIntervention 2023;19:e-e. DOI: 10.4244/EIJ-D-23-00590

Masaaki Nakase
Masaaki Nakase1, MD; Taishi Okuno1, MD; Daijiro Tomii1, MD; Bashir Alaour1, MD; Fabien Praz1, MD; Stefan Stortecky1, MD, MPH; Jonas Lanz1, MD, MSc; David Reineke2, MD; Stephan Windecker1, MD; Thomas Pilgrim1, MD, MSc
1. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland; 2. Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland

Background: The prognostic value of cardiac damage staging classifications across the haemodynamic spectrum of severe aortic stenosis (AS) remains unknown.

Aims: We aimed to investigate the prognostic impact of cardiac damage staging classifications in patients with high-gradient AS (HG-AS) and low-gradient AS (LG-AS) undergoing transcatheter aortic valve implantation (TAVI).

Methods: In a prospective TAVI registry, five-year mortality was evaluated for early stages of cardiac damage (stage 0, 1, or 2) and advanced stages of cardiac damage (stage 3 or 4) in patients with HG-AS, classical low-flow (LF) LG-AS, LF LG-AS with preserved ejection fraction (pEF), and normal-flow (NF) LG-AS.

Results: Among 2,090 patients undergoing TAVI, 1,045 patients had HG-AS, 337 patients had classical LF LG-AS, 394 patients had LF LG-AS with pEF, and 314 patients had NF LG-AS. The majority of patients with classical LF LG-AS exhibited advanced cardiac damage (73.6%), followed by LF LG-AS with pEF (55.6%), NF LG-AS (51.6%), and HG-AS (50.6%). Patients with advanced stage cardiac damage had significantly higher mortality after TAVI than those with early stage cardiac damage in all subtypes of AS (adjusted hazard ratio [HRadjusted] 1.66, 95% confidence interval [CI]: 1.34-2.06 for HG-AS; HRadjusted 1.49, 95% CI: 1.02-2.16 for classical LF LG-AS; HRadjusted 1.69, 95% CI: 1.22-2.35 for LF LG-AS with pEF; and HRadjusted 1.52, 95% CI: 1.04-2.32 for NF LG-AS).

Conclusions: Cardiac damage staging classifications stratified mortality after TAVI irrespective of AS subtype.

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