Elsevier

International Journal of Cardiology

Volume 296, 1 December 2019, Pages 98-102
International Journal of Cardiology

Significance of the CAPRI risk score to predict heart failure hospitalization post-TAVI: The CAPRI-HF study

https://doi.org/10.1016/j.ijcard.2019.08.033Get rights and content

Highlights

  • Heart failure remains a major concern after TAVI.

  • The CAPRI score is a TAVI dedicated risk score predictive of one-year mortality.

  • The CAPRI score is predictive of heart failure after TAVI.

  • The CAPRI score may help in the follow-up processes for TAVI patients.

Abstract

Background

Predictors of heart failure (HF) hospitalization after transcatheter aortic valve implantation (TAVI) are not well defined. CAPRI is a score for predicting 1-year post-TAVI cardiovascular and all-cause mortality. The aim of the present study is to assess the prognostic significance of the CAPRI score for HF hospitalization 1 year after TAVI.

Methods and results

CAPRI-HF is an ancillary study of the C4CAPRI trial, analyzing 409 consecutive patients treated by TAVI. The primary outcome was hospitalization for HF during the first year post-intervention. The prognostic value of the CAPRI score was assessed by multivariable analysis adjusted for diabetes, atrial fibrillation, vascular route, pacemaker implantation, post-TAVI aortic regurgitation, transfusion and pulmonary artery systolic pressure. A subanalysis focused on patients with low-gradient aortic stenosis (LGAS). At 1 year, HF hospitalization occurred in 78 (19.9%) patients. Patients with HF were more prone to have diabetes, atrial fibrillation, renal dysfunction, lower mean aortic gradient, higher logistic EuroSCORE and higher CAPRI score (p < .05 for all associations).

In the multivariable analysis, CAPRI score was the sole predictor of HF: hazard ratio (HR) for each 0.1 CAPRI score increase was 1.065, 95% confidence interval (CI) 1.021–1.110. This was confirmed when adjusted for EuroSCORE: HR 1.066, 95% CI 1.024–1.110. The predictive power of the CAPRI score increased for LGAS: HR 1.098, 95% CI 1.028–1.172.

Conclusions

CAPRI score helps predict HF post-TAVI. Including the score in the decision-making process may help selecting candidates for TAVI and identifying patients who need close monitoring post-procedure.

Introduction

The number of transcatheter aortic valve implantation (TAVI) procedures is increasing due to the recent extension of indications to patients at lower risk [1]. However, a substantial number of patients do not benefit from the procedure and rates of early death and repeated readmissions for heart failure (HF) remain an issue [2,3]. Outcomes can be improved by improving patient selection to avoid futile interventions and by improving treatment strategies in those patients at high residual risk of HF [4].

Predictors of HF hospitalization after TAVI are not well defined. Few studies have tackled this issue [2] and no standardized score is available to predict HF after TAVI. We have recently developed the CAPRI score to predict 1-year post-TAVI cardiovascular and all-cause mortalities [5]. This dedicated score includes thoracic aortic calcification (TAC) volume (assessed by CT scan) in addition to cardiac, vascular, and comorbid conditions. Our demonstration that TAC is predictive of mortality after TAVI independent of classical variables [6,7] has recently been confirmed by other groups [8].

We hypothesized that CAPRI score could also predict 1-year post-TAVI HF hospitalization since it encompasses several variables potentially involved in HF. Residual HF after TAVI is an even greater concern in low-gradient aortic stenosis (LGAS) patients [2]. There is a need for predictors in this population since classical cardiac and valvular parameters have failed to predict clinical outcomes after AS relief [9]. Because the CAPRI score includes TAC, a surrogate of aortic stiffness, it may be particularly relevant for LGAS which is often associated with high vascular load [10].

The aim of the present study was to assess the prognostic significance of the CAPRI score to predict HF hospitalization during the first year after TAVI in a consecutively treated population. We also tested the prognostic significance in a subset of patients with LGAS.

Section snippets

Methods

CAPRI-HF was an ancillary study of the C4CAPRI trial (4 Cities for assessing CAlcification PRognostic Impact NCT02935491), which was a multicenter study, performed in 4 high volume French centers [5].

Baseline data

Among the 409 patients, 14 peri-procedural deaths and 3 patients lost to follow-up were excluded. Thus, 392 patients were included in the study. 78 (19.9%) patients experienced at least one HF hospitalization. 60(15.3%) patients died during the follow-up, respectively 28(35.9%) patients of the 78 who experienced HF hospitalization and 32(10.2%) patients of the 314 who didn’t experience HF hospitalization, p < .001. Table 1 summarizes the characteristics of the cohort as well as according to the

Discussion

The present study demonstrates that the CAPRI score designed to predict one-year mortality after TAVI also predicts HF hospitalization. CAPRI score has been shown to be valuable for risk stratification before TAVI [5], and the present analysis indicates its utility in the follow-up of patients at risk of HF.

Despite procedural success, the risk of developing HF remains high after TAVI: HF hospitalization was experienced by 19.9% of patients in the present study and by up to 40% in other studies [

Study limitations

HF hospitalization wasn’t assessed in 2 of the 4 centers involved in the CAPRI study, however the number of patients included in the CAPRI HF study and the number of events allowed a robust analysis. The diagnosis of HF may be challenging [25]. However retaining only HF requiring hospitalization has certainly strengthened the robustness of the outcome. It has allowed us to check that the clinical judgment and the paraclinical tests were consistent with this diagnosis. Natriuretic peptides would

Conclusions

The CAPRI score is predictive of HF hospitalization after TAVI, including LGAS patients. Calculation of CAPRI scores may be valuable as part of the initial work-up for a more personalized evaluation of TAVI candidates. The score allows a better identification of poor responders to a TAVI procedure as well as of patients at high residual HF risk post-procedure.

Funding

None to disclose.

Declaration of competing interest

None.

References (25)

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1

This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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