Why the study?
Impaired left ventricular function independently predicts adverse clinical outcomes in aortic stenosis, prompting evaluation of short-term changes and adverse events after TAVR across different heart failure phenotypes.
Does TAVR improve echocardiographic parameters, BNP, and NYHA class in elderly patients with severe aortic stenosis across different heart failure phenotypes?
Cohort (n=96)
No
Does TAVR improve echocardiographic parameters, BNP, and NYHA class in elderly patients with severe aortic stenosis across different heart failure phenotypes?
TAVR provides significant short-term improvements in echocardiographic parameters, BNP, and NYHA class across all heart failure phenotypes in elderly patients with severe aortic stenosis, without increasing periprocedural complications in those with reduced ejection fraction.
Background Impaired left ventricular function is an independent predictor of adverse clinical outcomes in patients with aortic stenosis. The aim of this study is to evaluate the short-term changes of echocardiographic parameters, New York Heart Association (NYHA) class and B-type natriuretic peptide (BNP) level and adverse events amongst patients with heart failure (HF) after transcatheter aortic valve replacement (TAVR) procedure. Methods This was a retrospective cohort study conducted at affiliated Yantai Yuhuangding Hospital of Qingdao University between September 2017 and September 2022. TAVR cases were stratified into three groups [heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), heart failure with preserved ejection fraction (HFpEF)] by left ventricular ejection fraction (LVEF). Baseline characteristics, changes in echocardiographic parameters (1 week and 1 month), BNP (1 month), and NYHA class (6 months) post-TAVR were compared across the three groups. Meanwhile, we observed the adverse events of the patients after TAVR. Results A total of 96 patients were included, of whom 15 (15.6%) had HFrEF, 15 (15.6%) had HFmrEF, and 66 (68.8%) had HFpEF. Compared to the HFpEF subgroup, patients in the HFrEF subgroup were younger ( p < 0.05), and with a higher BNP ( p < 0.05). The left ventricular end-diastolic dimension (LVEDD) in HFrEF group decreased significantly after TAVR. HFmrEF and HFrEF patients showed significant improvements in LVEF after TAVR. The pulmonary artery systolic pressure (PASP), aortic valve peak gradient (AVPG) and aortic valve peak gradient (V max ) decreased significantly 1 month after TAVR in all three groups compared to the baseline (all p < 0.05). BNP significantly reduced in HFrEF group compared to HFpEF patients after TAVR ( p < 0.05). The majority of patients experienced an improvement at least one NYHA class in all three groups 6 months post-TAVR. There is no significant increase in the risk of adverse events in the HFrEF group. Conclusions Patients who underwent TAVR achieved significant improvements in BNP, NYHA class, LVEDD, LVEF, and PASP across the three HF classes, with a more rapid and pronounced improvement in the HFrEF and HFmrEF groups. Complication rates were low in the different HF groups. There is no significant increase in the risk of periprocedural complications in the HFrEF and HFmrEF groups.
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Dong et al. (2023) conducted a cohort in Severe aortic stenosis with heart failure (n=96). Transcatheter aortic valve replacement (TAVR) vs. Baseline values and comparison across heart failure phenotypes (HFrEF, HFmrEF, HFpEF) was evaluated on Short-term changes in echocardiographic parameters, NYHA class, and BNP level.
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