Jorge Nuche, Jules Mesnier, Julien Ternacle, Effat Rezaei, Francisco Campelo-Parada, Marina Urena, Gabriela Veiga-Fernandez, Luis Nombela-Franco, Anna Franzone, Antonio J Munoz-Garcia, Victoria Vilalta, Ander Regueiro, David Del Val, Lluis Asmarats, Maria Del Trigo, Vicenç Serra, Guillaume Bonnet, Melchior Jonveaux, Ronan Canitrot, Dominique Himbert, Jose Maria de la Torre Hernandez, Gabriela Tirado-Conte, Eduard Fernandez-Nofrerias, Pedro Cepas, Fernando Alfonso, Lola Gutierrez-Alonso, Juan Francisco Oteo, Yassin Belahnech, Siamak Mohammadi, Thomas Modine, Marisa Avvedimento, Josep Rodés-Cabau, Asim N Cheema
{"title":"Transcatheter Aortic Valve Replacement in Aortic Stenosis Patients With New York Heart Association Functional Class III or IV.","authors":"Jorge Nuche, Jules Mesnier, Julien Ternacle, Effat Rezaei, Francisco Campelo-Parada, Marina Urena, Gabriela Veiga-Fernandez, Luis Nombela-Franco, Anna Franzone, Antonio J Munoz-Garcia, Victoria Vilalta, Ander Regueiro, David Del Val, Lluis Asmarats, Maria Del Trigo, Vicenç Serra, Guillaume Bonnet, Melchior Jonveaux, Ronan Canitrot, Dominique Himbert, Jose Maria de la Torre Hernandez, Gabriela Tirado-Conte, Eduard Fernandez-Nofrerias, Pedro Cepas, Fernando Alfonso, Lola Gutierrez-Alonso, Juan Francisco Oteo, Yassin Belahnech, Siamak Mohammadi, Thomas Modine, Marisa Avvedimento, Josep Rodés-Cabau, Asim N Cheema","doi":"10.1016/j.cjca.2024.12.025","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. In this study we aimed to determine the rate, factors associated with, and prognostic value of poor functional status (New York Heart Association [NYHA] class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods: </strong>This multicenter study included 6363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I or II vs III or IV).</p><p><strong>Results: </strong>A total of 3800 (60%) patients presented with NYHA class III or IV before the TAVR procedure. Atrial fibrillation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11-1.58; P = 0.002), chronic kidney disease (CKD; OR, 1.73; 95% CI, 1.45-2.05; P < 0.001), chronic obstructive pulmonary disease (COPD; OR, 1.65; 95% CI, 1.32-2.05; P < 0.001), reduced left ventricular ejection fraction (OR, 2.28; 95% CI, 1.70-3.05; P < 0.001), and moderate and severe pulmonary hypertension were associated with a poor functional status. At 1-year follow-up, patients with NYHA class III or IV had higher rates of mortality (8.81 per 100 person-years [95% CI, 7.57-10.15] vs 13.12 per 100 person-years [95% CI, 11.80-14.58]; log rank, P < 0.001) and heart failure hospitalization (8.25 per 100 person-years [95% CI, 7.05-9.65] vs 12.5 per 100 person-years [95% CI, 11.24-14.00]; log rank, P = 0.005). Comorbidity factors (COPD, CKD) and signs of cardiac damage (atrial fibrillation, pulmonary hypertension) determined an increased risk of poorer clinical outcomes (P < 0.01 for all).</p><p><strong>Conclusions: </strong>More than half of the patients undergoing TAVR in the contemporary era have presented with advanced functional class before the procedure, and this was associated with a greater comorbidity and cardiac damage burden. Patients with poorer baseline functional status exhibited worse clinical outcomes at 1-year follow-up. These findings highlight the need for further study on earlier interventions for patients with aortic stenosis.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.8000,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cjca.2024.12.025","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. In this study we aimed to determine the rate, factors associated with, and prognostic value of poor functional status (New York Heart Association [NYHA] class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
Methods: This multicenter study included 6363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I or II vs III or IV).
Results: A total of 3800 (60%) patients presented with NYHA class III or IV before the TAVR procedure. Atrial fibrillation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11-1.58; P = 0.002), chronic kidney disease (CKD; OR, 1.73; 95% CI, 1.45-2.05; P < 0.001), chronic obstructive pulmonary disease (COPD; OR, 1.65; 95% CI, 1.32-2.05; P < 0.001), reduced left ventricular ejection fraction (OR, 2.28; 95% CI, 1.70-3.05; P < 0.001), and moderate and severe pulmonary hypertension were associated with a poor functional status. At 1-year follow-up, patients with NYHA class III or IV had higher rates of mortality (8.81 per 100 person-years [95% CI, 7.57-10.15] vs 13.12 per 100 person-years [95% CI, 11.80-14.58]; log rank, P < 0.001) and heart failure hospitalization (8.25 per 100 person-years [95% CI, 7.05-9.65] vs 12.5 per 100 person-years [95% CI, 11.24-14.00]; log rank, P = 0.005). Comorbidity factors (COPD, CKD) and signs of cardiac damage (atrial fibrillation, pulmonary hypertension) determined an increased risk of poorer clinical outcomes (P < 0.01 for all).
Conclusions: More than half of the patients undergoing TAVR in the contemporary era have presented with advanced functional class before the procedure, and this was associated with a greater comorbidity and cardiac damage burden. Patients with poorer baseline functional status exhibited worse clinical outcomes at 1-year follow-up. These findings highlight the need for further study on earlier interventions for patients with aortic stenosis.
期刊介绍:
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.