Evolution and prognostic impact of cardiac damage after aortic valve replacement

Genereux, P.; Pibarot, P.; Redfors, B.; Bax, J.J.; Zhao, Y.; Makkar, R.R.; ... ; Cohen, D.J. (2022)

Article / Letter to editor

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 inw15%, remained unchanged inw60%, and worsened in w25% 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. (C) 2022 by the American College of Cardiology Foundation.

• aortic stenosis
• aortic valve
• aortic valve replacement
• cardiac damage
• staging
• transcatheter aortic valve implantation
• transcatheter aortic valve replacement
• valve disease
• prognosis

• All authors: Genereux, P.; Pibarot, P.; Redfors, B.; Bax, J.J.; Zhao, Y.; Makkar, R.R.; Kapadia, S.; Thourani, V.H.; Mack, M.J.; Nazif, T.M.; Lindman, B.R.; Babaliaros, V.; Vincent, F.; Russo, M.; McCabe, J.M.; Gillam, L.D.; Alu, M.C.; Hahn, R.T.; Webb, J.G.; Leon, M.B.; Cohen, D.J.
• Date: 2022-08-15
• Journal: Journal of the American College of Cardiology
• Volume: 80
• Issue: 8
• Pages: 783 - 800
• DOI: doi:10.1016/j.jacc.2022.05.006