Transcatheter aortic valve replacement in aortic stenosis patients with New York Heart Association functional class III or IV.

IF 5.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology Pub Date : 2024-12-20 DOI:10.1016/j.cjca.2024.12.025

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, Vicenc 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

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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. This study aimed to determine the rate, factors associated with, and prognostic value of poor functional status (NYHA class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).

Methods: This multicenter study included 6,363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I-II vs. III-IV).

Results: A total of 3,800 (60%) patients presented an NYHA class III-IV before the TAVR procedure. Atrial fibrillation (OR:1.32,95%CI:1.11-1.58,p=0.002), chronic kidney disease (OR:1.73, 95%CI:1.45-2.05, p<0.001), COPD (OR:1.65,95%CI: 1.32-2.05), p<0.001), reduced LVEF (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-IV presented a higher rate of mortality (8.81 per 100 person-years, 95%CI: 7.57-10.15 vs. 13.12 per 100 person-year - 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 one-half of patients undergoing TAVR in the contemporary era presented an 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 importance of future studies on earlier interventions for aortic stenosis patients.

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来源期刊

Canadian Journal of Cardiology 医学-心血管系统

CiteScore

9.20

自引率

8.10%

发文量

546

审稿时长

32 days

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.