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. 2025 Nov;114(11):1516-1526.
doi: 10.1007/s00392-024-02582-4. Epub 2024 Dec 9.

Eccentric hypertrophy impairs outcome after TAVR

R Thalmann #  1 , V Obermeier #  1   2 , Dominik S Westphal #  3   4   5 , I Diebold  6   7 , T Trenkwalder  2   8 , C Pellegrini  2   8 , G Buglio  1 , H Seoudy  9   10 , P Hoppmann  1 , C Bradaric  1 , U Schön  6 , E Holinski-Feder  6 , N Lettmann  1 , H Ruge  11 , M Erlebach  11 , C Fuetterer  12 , K L Laugwitz  1   2 , M Krane  11 , D Frank  9   10 , C Kupatt  1   2
Affiliations

Eccentric hypertrophy impairs outcome after TAVR

R Thalmann et al. Clin Res Cardiol. 2025 Nov.

Abstract

Background: Aortic stenosis (AS) induces cardiac remodeling upon chronic left ventricular (LV) pressure overload. Here, we analyzed the clinical outcome of patients undergoing transcatheter aortic valve replacement (TAVR) for symptomatic AS with regard to varying LV hypertrophy patterns. Moreover, we investigated the genetic influence on development of different hypertrophy patterns, measured by polygenic risk scores (PRS).

Methods: 1703 patients with severe AS undergoing TAVR were categorized according to LV mass index and relative wall thickness in four subgroups: normal geometry (NG, n = 57), concentric remodeling (CR; n = 388), concentric hypertrophy (CH; n = 993) and eccentric hypertrophy (EH; n = 265). Data was analyzed retrospectively with regard to clinical outcome. In a substudy, 520 patients affected by CH (n = 237), EH (n = 139) or CR (n = 164) were analyzed using two PRS that have been previously associated with hypertrophic and dilated cardiomyopathy.

Results: 1 year after TAVR, for EH, in contrast to the remaining groups (NG, CR, CH), a significant difference in all-cause mortality was observable (mortality 17.4% EH, 14.0% NG, 12.4% CR, 14.0% CH, p = 0.001). This difference was observed up to 4 years (mortality 41.9% EH, 26.9% CH, 28.1% CR, 26.4% NG, p = 0.001). Of note, higher percentiles in a PRS for hypertrophic cardiomyopathy were associated with a reduced likelihood of EH in patients with AS (p = 0.046).

Conclusions: The EH group had a statistically significant poorer 1-year and 5-year outcomes than the other groups. PRS might help predict myocardial reactions in patients with aortic stenosis in future.

Keywords: Cardiomyopathy; Hypertrophy; Outcome; Polygenic risk score; TAVR; Transcatheter aortic valve replacement.

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Conflict of interest statement

Declarations. Conflict of interest: The authors report no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart depicting the study design and population. A total of 1703 patients that underwent transcatheter aortic valve replacement were included in this study in divided according to their hypertrophy pattern. A subgroup of 540 patients was included into the genetic analysis. CH concentric hypertrophy, CR concentric remodeling, EH eccentric remodeling, LV left ventricular
Fig. 2
Fig. 2
Kaplan–Meier estimates of the 30-day survival function after TAVR in the 4 groups determined by hypertrophy. Blue: patients with normal hypertrophy, green: patients with concentric remodeling, red: patients with concentric hypertrophy, orange: patients with eccentric hypertrophy
Fig. 3
Fig. 3
Mid-term survival after TAVR; Kaplan–Meier estimates of the survival function after TAVR in the 4 groups determined by hypertrophy. Blue: patients with normal hypertrophy, green: patients with concentric remodeling, red: patients with concentric hypertrophy, orange: patients with eccentric hypertrophy
Fig. 4
Fig. 4
Scatterplot depicting the distribution of the measured PRS for DCM and HCM. There was an inverse correlation between the two measured polygenic risk scores in all three groups. Overall in patients with a high HCM-PRS value, low values for the DCM-PRS were observed. CH concentric hypertrophy (purple), CR concentric remodeling (green), EH eccentric remodeling (orange), DCM-PRS polygenic risk score for dilated cardiomyopathy, HCM-PRS polygenic risk score for hypertrophic cardiomyopathy
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