Evolution and Prognostic Impact of Cardiac Damage After Aortic Valve Replacement

Philippe Généreux; Philippe Pibarot; Björn Redfors; Jeroen J Bax; Yanglu Zhao; Raj R Makkar; Samir Kapadia; Vinod H Thourani; Michael J Mack; Tamim M Nazif; Brian R Lindman; Vasilis Babaliaros; Flavien Vincent; Mark Russo; James M McCabe; Linda D Gillam; Maria C Alu; Rebecca T Hahn; John G Webb; Martin B Leon; David J Cohen

doi:10.1016/j.jacc.2022.05.006

Evolution and Prognostic Impact of Cardiac Damage After Aortic Valve Replacement

J Am Coll Cardiol. 2022 Aug 23;80(8):783-800. doi: 10.1016/j.jacc.2022.05.006. Epub 2022 May 17.

Authors

Philippe Généreux¹, Philippe Pibarot², Björn Redfors³, Jeroen J Bax⁴, Yanglu Zhao⁵, Raj R Makkar⁶, Samir Kapadia⁷, Vinod H Thourani⁸, Michael J Mack⁹, Tamim M Nazif¹⁰, Brian R Lindman¹¹, Vasilis Babaliaros¹², Flavien Vincent¹³, Mark Russo¹⁴, James M McCabe¹⁵, Linda D Gillam¹⁶, Maria C Alu¹⁷, Rebecca T Hahn¹⁷, John G Webb¹⁸, Martin B Leon¹⁷, David J Cohen¹⁹

Affiliations

¹ Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA. Electronic address: philippe.genereux@atlantichealth.org.
² Department of Medicine, Laval University, Quebec, Quebec, Canada.
³ Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
⁵ Edwards Lifesciences, Irvine, California, USA.
⁶ Cedars Sinai Medical Center, Los Angeles, California, USA.
⁷ Cleveland Clinic, Cleveland, Ohio, USA.
⁸ Piedmont Heart Institute, Atlanta, Georgia, USA.
⁹ Baylor Scott and White Research Institute, Plano, Texas, USA.
¹⁰ Columbia University Irving Medical Center, New York, New York, USA.
¹¹ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹² Emory University School of Medicine, Atlanta, Georgia, USA.
¹³ Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Lille University Hospital, Lille, France.
¹⁴ Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
¹⁵ University of Washington, Seattle, Washington, USA.
¹⁶ Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
¹⁷ Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA.
¹⁸ St. Paul's Hospital, Vancouver, British Columbia, Canada.
¹⁹ Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA.

PMID: 35595203
DOI: 10.1016/j.jacc.2022.05.006

Abstract

Background: The impact of aortic valve replacement (AVR) on progression/regression of extravalvular cardiac damage and its association with subsequent prognosis is unknown.

Objectives: The purpose of this study was to describe the evolution of cardiac damage post-AVR and its association with outcomes.

Methods: Patients undergoing transcatheter or surgical AVR from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were pooled and classified by cardiac damage stage at baseline and 1 year (stage 0, no damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary vasculature or tricuspid valve damage; and stage 4, right ventricular damage). Proportional hazards models determined association between change in cardiac damage post-AVR and 2-year outcomes.

Results: Among 1,974 patients, 121 (6.1%) were stage 0, 287 (14.5%) stage 1, 1,014 (51.4%) stage 2, 412 (20.9%) stage 3, and 140 (7.1%) stage 4 pre-AVR. Two-year mortality was associated with extent of cardiac damage at baseline and 1 year. Compared with baseline, cardiac damage improved in ∼15%, remained unchanged in ∼60%, and worsened in ∼25% of patients at 1 year. The 1-year change in cardiac damage stage was independently associated with mortality (adjusted HR for improvement: 0.49; no change: 1.00; worsening: 1.95; P = 0.023) and composite of death or heart failure hospitalization (adjusted HR for improvement: 0.60; no change: 1.00; worsening: 2.25; P < 0.001) at 2 years.

Conclusions: In patients undergoing AVR, extent of extravalvular cardiac damage at baseline and its change at 1 year have important prognostic implications. These findings suggest that earlier detection of aortic stenosis and intervention before development of irreversible cardiac damage may improve global cardiac function and prognosis. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk [PII A], NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII B [PARTNERII B], NCT02184442; and PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3], NCT02675114).

Keywords: aortic stenosis; aortic valve; aortic valve replacement; cardiac damage; prognosis; staging; transcatheter aortic valve implantation; transcatheter aortic valve replacement; valve disease.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Valve / surgery
Aortic Valve Stenosis* / diagnosis
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis* / adverse effects
Humans
Prognosis
Risk Factors
Severity of Illness Index
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02675114
ClinicalTrials.gov/NCT01314313
ClinicalTrials.gov/NCT02184442