September 22, 2022
3 minutes read
Genereux P, et al. Late-Breaking Clinical Science Session in Structural Heart Disease: Session IV, in collaboration with the Journal of the American College of Cardiology. Presented at: TCT Scientific Symposium; 16-19 Sept 2022; Boston (hybrid meeting).
Généreux announces financial affiliations with 4C Medical, Abbott Vascular, Abiomed, BioTrace Medical, Boston Scientific, Caranx Medical, Cardiovascular Systems Inc., Edwards Lifesciences, GE Healthcare, iRhythm Technologies, Medtronic, Opsens, Puzzle Medical, Saranas, Shockwave, Siemens, Soundbite medicine and teleflex.
BOSTON — In patients with aortic stenosis, a greater degree of heart damage prior to transcatheter or surgical aortic valve replacement increased the likelihood of poor quality of life after the procedure, researchers reported.
In addition, improvement in cardiac damage stage after AVR was associated with better quality of life at 1 year compared to no change or deterioration.
The extent of cardiac damage after TAVR or surgical AVR had previously been shown to be related to clinical outcomes at 1 year post-procedure, Philip GeneReux, M.D. Co-Director of the Structural Heart Program at Morristown Medical Center, Atlantic Health System, Morristown, NJ during a press conference at TCT 2022.
“In 2017, we presented this new concept of grading aortic stenosis based on the extent of heart damage,” Généreux said during the press conference. “What we discovered is that the extent of cardiac damage 1 year after AVR was associated with mortality and adverse events, and that worsening of these stages from baseline to 1 year was associated with an increased risk of death and repeat hospitalizations at 2 years. What we don’t know is the impact of AVR and heart damage on quality of life.”
Généreux and colleagues analyzed 1,974 patients from the PARTNER studies who had undergone TAVR with a balloon expandable valve (Sapien family of products, Edwards Lifesciences) or surgical AVR and who had complete aortic stenosis staging data from baseline echocardiography.
Patients were stratified into quintiles based on baseline staging data: stage 0 (6.1%) indicated no damage, stage 1 (14.5%) indicated left ventricular damage, stage 2 (51.4 %) indicated left atrial/mitral valve damage, stage 3 (20.9%) indicated pulmonary artery/tricuspid damage, and stage 4 (7.1%) indicated right ventricular damage.
The baseline Kansas City Cardiomyopathy Questionnaire-Overall Summary Score (KCCQ-OS) (P for trend P for trend P = 0.011), Généreux said during the press conference.
“The good news is that at 1 year, regardless of your stage, you were still benefiting from AVR, whether it was TAVR or surgery,” he said. “But what we’ve seen is that as the level of heart damage increases, you increase the rate of poor health outcomes.”
At 1 year, the higher the stage of cardiac damage, the more likely a patient was to die, have a KCCQ-OS less than 60, or experience the combination of death, a KCCQ-OS less than 60, or KCCQ-OS regression at the start of the study was at least 10 (P P = 0.76).
In a multivariate model, each 1-level increase in baseline heart damage resulted in a 24% increased risk of poor health (OR = 1.24; 95% CI, 1.09-1.41; P = 0.001).
Among the 1,120 patients with available echocardiograms at 1 year, the stage of cardiac damage improved in 15.6%, remained unchanged in 57.9% and worsened in 26.5%, Généreux said.
Those with improvement in heart damage stage had the greatest improvement in KCCQ-OS at 1 year, followed by those with no change and then those with worsening (+26.8 vs +21.4 vs +17.5; P for trend
“The development of the heart damage had a real impact on the quality of life after one year,” Généreux said during the press conference. “Regression of heart damage at 1 year was associated with greater improvement in health status compared to patients whose heart damage was unchanged or worsening. We believe that recognizing [aortic stenosis] aggressively before irreversible heart damage occurs may help improve long-term outcomes after AVR. Longer follow-up is required to characterize the impact of aortic stenosis and its stage on AVR and quality of life afterwards.”