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. 2025 Apr 30;26(5):918-927.
doi: 10.1093/ehjci/jeaf045.

The reversibility of cardiac damage after transcatheter aortic valve implantation and short-term outcomes in a real-world setting

Rinchyenkhand Myagmardorj  1   2 , Federico Fortuni  1   3 , Philippe Généreux  4 , Takeru Nabeta  1 , Jan Stassen  1   5 , Xavier Galloo  1   6 , Maria Chiara Meucci  1 , Steele Butcher  1 , Frank van der Kley  1 , David J Cohen  7   8 , Marie-Annick Clavel  9 , Philippe Pibarot  9 , Martin B Leon  7   10 , Madelien V Regeer  1 , Victoria Delgado  11 , Nina Ajmone Marsan  1 , Jeroen J Bax  1   12
Affiliations

The reversibility of cardiac damage after transcatheter aortic valve implantation and short-term outcomes in a real-world setting

Rinchyenkhand Myagmardorj et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: This study aims to assess the changes in cardiac damage stage in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI), and to investigate the prognostic value of cardiac damage stage evolution.

Methods and results: Patients with severe aortic stenosis (AS) undergoing TAVI were retrospectively analysed. A five-stage system based on the presence and extent of cardiac damage assessed by echocardiography was applied before and 6 months after TAVI. Multivariable Cox regression analyses were used to examine independent prognostic value of the changes in cardiac damage after TAVI. A total of 734 patients with severe AS (mean age, 79.8 ± 7.4 years; 55% male) were included. Before TAVI, 32 (4%) patients did not show any sign of extra-valvular cardiac damage (Stage 0), 85 (12%) had left ventricular damage (Stage 1), 220 (30%) left atrial and/or mitral valve damage (Stage 2), 227 (31%) pulmonary vasculature and/or tricuspid valve damage (Stage 3), and 170 (23%) right ventricular damage (Stage 4). Six months after TAVI, 39% of the patients improved at least one stage in cardiac damage. Staging of cardiac damage at 6 months after TAVI [hazard ratio (HR) per one-stage increase, 1.391; P = 0.035] as well as worsening in the stage of cardiac damage (HR, 3.729; P = 0.005) were independently associated with 2-year all-cause mortality.

Conclusion: More than one-third of patients with severe AS showed an improvement in cardiac damage 6 months after TAVI. Staging cardiac damage at baseline and follow-up may improve risk stratification in patients undergoing TAVI.

Keywords: aortic stenosis; echocardiography; prognosis; transcatheter aortic valve implantation.

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Conflict of interest statement

Conflict of interest: The Department of Cardiology, Heart Lung Center, Leiden University Medical Centre has received research grants from Abbott Vascular, Alnylam, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Medtronic, Pie Medical, Medis, Pfizer and Novartis. D.J.C. received research grant support from Edwards Lifesciences, Boston Scientific, Abbott, Medtronic, JC Medical, and Jena Valve and consulting services from Edwards Lifesciences, Boston Scientific, and Abbott. V.D. received speaker fees from Abbott Vascular, Medtronic, Edwards Lifesciences, Novartis, JenaValve, Philips and GE Healthcare. F.v.d.K. received speaker’s and consulting fees from Abbott and Edwards Lifesciences. N.A.M. received speaker’s fees from Abbott Vascular, Philips Ultrasound, Omron, GE Healthcare, and Pfizer. J.J.B. received speaker fees from Abbott Vascular, Edwards Lifesciences, and Omron. The remaining authors have nothing to disclose. Therefore, M.-A.C. is an Associate Editor, European Heart Journal, Cardiovascular Imaging. P.P. is a member of the International Editorial Board, European Heart Journal, Cardiovascular Imaging. N.A.M. is a liaison editor to European Heart Journal, Cardiovascular Imaging. J.J.B. is a member of the International Editorial Board, European Heart Journal, Cardiovascular Imaging.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Patient inclusion flow-chart. AS, aortic stenosis; FU, follow-up; LVOT, left ventricular outflow tract; TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2
Stages of cardiac damage in severe aortic stenosis. The Figure illustrates the echocardiographic-based cardiac damage staging system that was applied before and after TAVI. LV, left ventricular; TAPSE, tricuspid annular plane systolic excursion; TAVI, transcatheter aortic valve implantation.
Figure 3
Figure 3
Kaplan–Meier survival curves for all-cause death according to cardiac damage assessed at baseline (A) and 6-month follow-up (B). Both in the baseline (A) and follow-up (B) survival analysis, cardiac damage stages from 0 to 3 had significantly lower event rates compared to Stage 4 based on pairwise comparison analysis (P-value <0.05 for all pairwise comparisons with all the other cardiac damage stages).
Figure 4
Figure 4
Evolution of baseline cardiac damage at 6-month follow-up per each stage. Each colour-coded rectangular box corresponds to baseline cardiac damage stages. Each pie chart shows the evolution of the baseline cardiac damage at 6-month follow-up after TAVI. Black colour denotes patients who died within 6 months after TAVI (n = 72). The other colours in the pie chart represent the cardiac damage stages as coded at baseline. LV, left ventricular; TAVI, transcatheter aortic valve implantation.
See this image and copyright information in PMC

References

    1. Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh Met al. . Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990–2017. Circulation 2020;141:1670–80. - PubMed
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo Met al. . Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019;380:1695–705. - PubMed
    1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LGet al. . Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187–98. - PubMed
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SKet al. . Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374:1609–20. - PubMed
    1. Lindman BR, Maniar HS, Jaber WA, Lerakis S, Mack MJ, Suri RMet al. . Effect of tricuspid regurgitation and the right heart on survival after transcatheter aortic valve replacement: insights from the placement of aortic transcatheter valves in inoperable cohort. Circ Cardiovasc Interv 2015;8:10. - PMC - PubMed

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