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Multicenter Study
. 2025 Sep;106(3):1828-1836.
doi: 10.1002/ccd.70003. Epub 2025 Jul 11.

Less Symptom Improvement in Patients Undergoing TAVI With Concomitant COPD, Atrial Fibrillation and Heart Failure

Kees H van Bergeijk  1 , Constantijn S Venema  1 , Bob Ophuis  1 , Luca H Plekkenpol  1 , Mara Tomei  1 , Hayman Al-Barwary  1 , Jasper Tromp  1   2 , Yoran M Hummel  3 , Wouter Ouwerkerk  4   5 , Ad F M van den Heuvel  1 , Hindrik W van der Werf  1 , Yvonne L Douglas  1 , Jonas Lanz  6 , Stefan Stortecky  6 , Daijiro Tomii  6 , Thomas Pilgrim  6 , Stephan Windecker  6 , Edoardo Pancaldi  7 , Matteo Pagnesi  7 , Marianna Adamo  7 , Adriaan A Voors  1 , Joanna J Wykrzykowska  1
Affiliations
Multicenter Study

Less Symptom Improvement in Patients Undergoing TAVI With Concomitant COPD, Atrial Fibrillation and Heart Failure

Kees H van Bergeijk et al. Catheter Cardiovasc Interv. 2025 Sep.

Abstract

Background: Comorbidities like a history of chronic obstructive pulmonary disease (COPD), atrial fibrillation (AF) and heart failure (HF) can cause similar symptoms as aortic stenosis (AS). However, how they influence symptom improvement and long-term outcomes after transcatheter aortic valve implantation (TAVI) is unclear.

Aims: To study the impact of COPD, AF and HF on outcomes after TAVI.

Methods: A history of COPD, AF and HF were collected in three TAVI cohorts (Groningen, Netherlands, Brescia, Italy and Bern, Switzerland). Symptom improvement was defined as ≥ 1 improvement of New York Heart Association (NYHA) functional class at 12 months, compared with baseline. Adverse events were defined as cardiovascular mortality, stroke or HF-hospitalisation at 5-year follow-up (VARC-3).

Results: The pooled analysis included 5173 patients (mean age: 81.5 years, 49.7% women). Patients with COPD, AF or HF underwent TAVI at significantly lower mean aortic valve gradients, higher cardiac damage stage and higher NYHA-class. After adjusting for sex, NYHA-class, age, other comorbidities, flow-type and cardiac damage stage pre-TAVI, a history of COPD (Odds Ratio (OR): 1.75 (95% Confidence interval (CI): 1.10-2.75), p = 0.017) and a history of HF (1.65 (1.03-2.58), p = 0.038) were associated with no symptom improvement, while AF was not (1.12 (0.71-1.74, p = 0.629). Patients with COPD, AF or HF had higher risks of adverse events and lower survival at long-term follow-up.

Conclusions: Patients with symptomatic AS and concomitant comorbidities of COPD, AF and HF, undergo TAVI at a lower severity of AS, have a higher symptomatic burden and higher cardiac damage stage before TAVI. They have a greater risk of residual symptoms, and a higher risk of long-term adverse events.

Keywords: COPD; TAVI; atrial fibrillation; heart failure; symptoms.

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Conflict of interest statement

Jasper Tromp is supported by the National University of Singapore Start‐up grant, the tier 1 grant from the Ministry of Education and the CS‐IRG New Investigator Grant from the National Medical Research Council; has received research support from AstraZeneca and consulting or speaker fees from Us2.ai, and owns patent US‐10702247‐B2 unrelated to the present work. Yoran M. Hummel received contracts from US2.ai as employee. Wouter Ouwerkerk received consulting fees from US2.ai as medical advisor. Thomas Pilgrim reports research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the Swiss Polar Institute, and the Bangerter‐Rhyner Foundation. Research, travel or educational grants to the institution without personal remuneration from Biotronik, Boston Scientific, Edwards Lifesciences, and ATSens; speaker fees and consultancy fees to the institution from Biotronik, Boston Scientific, Edwards Lifesciences, Abbott, Medtronic, Biosensors, and Highlife. Stephan Windecker reports Research, travel or educational grants to the institution from Abbott, Abiomed, Amgen, Astra Zeneca, Bayer, Bbraun, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Cleerly Inc., Cordis Medical, Corflow Therapeutics, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Farapulse Inc. Fumedica, GE Medical Systems, Gebro Pharma, Guerbet, Idorsia, Inari Medical, InfraRedx, Janssen‐Cilag, Johnson & Johnson, Medalliance, Medicure, Medtronic, Merck Sharp & Dohm, Miracor Medical, Neucomed, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pharming Tech, Pfizer, Philips AG, Polares, Regeneron, Sanofi‐Aventis, Servier, Siemens Healthcare, Sinomed, SMT Sahajanand Medical Technologies, Terumo, Vifor, V‐Wave, Zoll Medical. He is Advisory board member and/or member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, Astra Zeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, and V‐Wave with payments to the institution but no personal payments. Matteo Pagnesireportspersonal fees from AstraZeneca, Abbott Vascular, Boehringer Ingelheim, Novartis, Roche Diagnostics and Vifor Pharma. Mariana Adamo reports consulting fees from Abbott Vascular and Edwards Lifesciences. Dr. Voors received research grants from AnaCardio, Bayer, BMS, Boehringer Ingelheim, Corteria, Cytokinetics, Eli Lilly, Merck, Novartis, Novo Nordisk, Roche Diagnostics, Pfizer and Moderna and consulting fees from AnaCardio, Bayer, BMS, Boehringer Ingelheim, Corteria, Cytokinetics, Eli Lilly, Merck, Novartis, Novo Nordisk and Roche Diagnostics. Dr. Wykrzykowska received research grants from Medtronic and US2.ai and consulting fees from BSC, Abbot, Meril, Medtronic, Novo Nordisk, SMT, Sinomed and Medis. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Forest plot for lack of symptom improvement. Odds Ratios (OR) for lack of symptom improvement, 1‐year after TAVI. *Adjusted for sex, age, NYHA class pre‐TAVI, AF and/or COPD and cardiac damage and flow‐type. A p value of < 0.05 was considered as statistically significant. AF, Atrial fibrillation; COPD, chronic obstructive pulmonary disease; HF, heart failure; NYHA, New York Heart Association.
Figure 2
Figure 2
Kaplan Meier curves for comorbidities and long‐term mortality. Kaplan Meier (KM) Curves for cardiovascular mortality 5‐year after TAVI, in the Groningen cohort only. A p value of < 0.05 was considered as statistically significant. AF, Atrial fibrillation; COPD, chronic obstructive pulmonary disease; HF, heart failure; NYHA, New York Heart Association. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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