Significance of the CAPRI risk score to predict heart failure hospitalization post-TAVI: The CAPRI-HF study
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)
- et al.
Incidence, prognostic impact, and predictive factors of readmission for heart failure after transcatheter aortic valve replacement
JACC Cardiovasc. Interv.
(2017) - et al.
Late cardiac death in patients undergoing transcatheter aortic valve replacement: incidence and predictors of advanced heart failure and sudden cardiac death
J. Am. Coll. Cardiol.
(2015) - et al.
Development of a risk score based on aortic calcification to predict 1-year mortality after transcatheter aortic valve replacement
J. Am. Coll. Cardiol. Img.
(2019) - et al.
Aortic calcifications present the next challenge after TAVR
J. Am. Coll. Cardiol.
(2015) - et al.
Aorta calcification burden: towards an integrative predictor of cardiac outcome after transcatheter aortic valve implantation
Atherosclerosis
(2016) - et al.
Transcatheter aortic valve replacement in patients with low-flow, low-gradient aortic stenosis: the TOPAS-TAVI registry
J. Am. Coll. Cardiol.
(2018) - et al.
Low-flow aortic stenosis in asymptomatic patients: valvular-arterial impedance and systolic function from the SEAS substudy
J. Am. Coll. Cardiol. Img.
(2009) - et al.
Long-term outcomes in patients with new permanent pacemaker implantation following transcatheter aortic valve replacement
JACC Cardiovasc. Interv.
(2018) - et al.
Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes
J. Am. Coll. Cardiol.
(2006) - et al.
Systemic vascular load in calcific degenerative aortic valve stenosis: insight from percutaneous valve replacement
J. Am. Coll. Cardiol.
(2015)
Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment
J. Am. Coll. Cardiol.
TAC for TAVR: what is the score?
JACC Cardiovasc. Imaging
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.